Use this form to request or report the following: repair of street or potholes, reporting of hazardous sidewalk condition, street or gutter drainage problems, bike paths and catch basin stoppages, street sign issues, traffic signal outage, streetlight outage (provide streetlight pole number). Your name, telephone number, and e-mail address are not required, but are helpful should questions arise.

Reported location must be within the City of West Memphis. The exact reported location/site address is required.

Please use one form per request!

Contact Information

Name:*

Phone Number:*

Street Address:*

Email Address:

Exact Location of Job Requested

Street Name, Address or Block Number:*

Nearest Two Cross Streets:

Nature of Request:*