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2. Name
4. Your Address
6. City
8. Postal Code
10. Phone
12. Email
14. Single Street Light Out

    1. Yes
    2. No
15. Multiple Street Lights Out

    1. Yes
    2. No
17. Light Cycling On and Off

    1. Yes
    2. No
18. Light Flickering

    1. Yes
    2. No
20. Light on During Daylight Hours

    1. Yes
    2. No
21. Broken Glass

    1. Yes
    2. No
23. Damaged Pole

    1. Yes
    2. No
24. Exposed Wires

    1. Yes
    2. No
26. Other, please describe
28. Street Light Location

    If this is a BC Hydro Pole and you have the pole number, enter it here. For all non BC Hydro Street Lights, please fill out the following form to the best of your ability. The more information you can provide, the better.

30. BC Hydro Pole Number
32. Which subdivision is this light located in?
    -- Select One --NoneCrestviewFairway GreensHighlandsMountview
34. What is the closest address to the light for which you are reporting the problem?
36. Where is the problem light located in relation to that street address?
38. Location Description
40. Additional Comments
42. Reply to Email Address*
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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field