Maui County Streetlight Form

Maui County Streetlight Repair Request

Date :

Contact Information:

* First Name

* Last Name

* Phone

* Street #

* Street Name

* City

* Zip Code

* Streetlight #/Barcode

(If the # is not known, note "none found")

* Streetlight Problem

Light Out

Light Flickering

Light Dim

Pole Broken or Leaning

Other

Short description of streetlight location

Remarks/Comments

Security Check