CITY OF JACKSON, MICHIGAN REQUEST FOR SERVICE / ACTION FORM

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CITY OF JACKSON CUSTOMER REQUEST FOR SERVICE / ACTION
This Requests for Service/Action form is not intended for emergencies. Requests for service/action are received and
processed during normal business hours: weekdays from 8:00 AM to 5:00 PM

First Name:

Message

Last Name:

Company:

Address:

Address (Line 2):

City:

State:

Zip:

Email:

Telephone

Fax:

Preferred Method of Contact	Email	Telephone	Fax
Preferred Method of Contact	Postal Service	Not Required
Please enter the code in box Ltk876SM