Clanton: Action Center

Action Center

* DENOTES A REQUIRED FIELD

1. Select the type of problem that you are reporting.

*Nature of Problem:

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 problem that you are reporting in the space provided.

Location:

Contact Information

Name:

*E-Mail:

Address:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell Phone: