Street Light Maintenance Request

Please tell us about the streetlight:
*Street Address:
Apt/Lot/Unit Number:
*Location Details:
Locked Gate or Entry Code required
Animals need to be secured prior to arrival
*Type of Problem:
Please provide your contact information:
Coastal Electric Account Number:
Full Name:
Work Phone Number:
Mobile Phone Number:
Fax Phone Number:
*Email Address:
*Daytime Telephone Number:    (M-F between 8 AM & 5 PM)
Best time to call:
Comments:





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