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text here 9/7/2010
Columbiana City Hall
107 Mildred Street
Columbiana, Alabama 35051
Telephone:
(205) 669-5800
Fax:
(205) 669-5811
Action Center
*
DENOTES A REQUIRED FIELD
1. Select the type of issue that you are reporting.
*
Nature of Problem:
Please select an action
Pothole
Missing or Damaged Street Sign
Broken Water Main
Other...
2. Briefly
describe your request
in the space provided. Please be as specific as possible.
*
Description of Problem:
3. Enter the
address or location
as well as the nearest intersection of the issue that you are reporting in the space provided.
*
Location:
Contact Information:
<OPTIONAL>
If you would like a response, you MUST provide an email address or phone number.
Name:
E-Mail:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
text here 9/7/2010
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