Traffic Complaint Form

DO NOT USE THIS FORM TO REPORT VEHICLE COLLISIONS (ACCIDENTS) OF ANY KIND.

DO NOT USE THIS FORM TO REPORT TRAFFIC PROBLEMS THAT ARE IN PROGRESS, OR HAVE JUST OCCURRED.

DIAL 9-1-1 FOR EMERGENCY SITUATIONS.

DIAL 329-2413 FOR NON EMERGENCY SITIATIONS.

Incident Information

* Type of Traffic Problem

Other (If applicable)

* Address where the problem is occurring and nearest cross-street (i.e. 250 Hamilton Ave at Bryant St)

Date when problem occurred (mm/dd/yyyy)

Time of Problem (hh:mm am/pm)

Other Time Information (i.e. During communte hours)

* Description of Traffic Problem

Vehicle Information

Year of Vehicle (Example: 1954)

Make (Example: Mazda, Dodge)

Model (Example: Protege, Durango)

Body Style (Example: Sedan, SUV)

Color (Example: Graphite, Black)

License Number

License State

Reporting Person's Information

If you would like a return response about your complaint, please provide the information below and we will contact you as soon as possible.

Thank you for helping us to better serve you.

* First Name

Middle Name

* Last Name

Phone

Birthdate

Address 1

Address 2

City

State

Zip

* Home Phone

Work Phone

* Email