Welcome to City of High Point Form Center

2. First Name*
3. Last Name*
5. Daytime Phone*
6. Ext.
8. Email
10. Would you like someone to contact you?

    1. Yes
    2. No
12. Was your service request made:

    1. Online
    2. Phone
    3. In Person
14. Briefly describe the service request.
    Examples: trim trees, repair streetlight, pick up garbage, test water, etc.
16. Date of Request
    Date of Request
18. Location of Request
20. If request was made by phone or in person was our Customer Service Representative courteous?

    1. Yes
    2. No
    3. N/A
22. Did we respond when we said we would?

    1. Yes
    2. No
24. If not, did we let you know there would be a delay?

    1. Yes
    2. No
26. Was the field crew who responded courteous?

    1. Yes
    2. No
    3. N/A
28. Please provide any other comments you may want to share:
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field