Citizen Request Form

2. 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.

4. If this is a police or traffic related issue, call the Wall Township Police Department at 732-449-4500.

   If this is a police or traffic related issue, call the Wall Township Police Department at 732-449-4500.

6. Reported location must be within the boundaries of Wall Township. The exact reported location/site address is required

8. Please use one form per request!

12. Contact Information

14. First Name

15. Last Name

17. Phone Number

18. Email Address *

20. Street Address:

22. Exact Location of Job Requested

24. Street Name, Address or Block Number*

26. Nearest Two Cross Streets

28. Nature of Request*

Leave This Blank:


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

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field