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2. Fix It Form

   By completing and submitting a Fix It Form, you will be alerting the City of problems or concerns in your area, which will allow for a quicker response time. Should a problem require urgent attention, please call us immediately. For a police emergency, dial 911. Otherwise, call 479-524-5136. Thank you for your assistance!

4. Contact Information
6. First Name*
7. Last Name*
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Phone Number*
18. Email Address*
20. What ward are you in?
    Ward Map

    Please choose what ward you live in.
21. Choose your ward
    -- Select One --Ward 1 (northwest)Ward 2 (northeast)Ward 3 (southeast)Ward 4 (southwest)I am a visitor to Siloam Springs
23. 1. Pothole
    2. Damaged curb
    3. Traffic signals
    4. Weeds
    5. Dogs barking
    6. Abandoned vehicles
    7. Chemical discharge

    1. Water leaking
    2. Litter
    3. Road striping
    4. ADA Complaint
    5. Blocked drainage channel
    6. Street Lights
    7. Damaged sidewalk

    1. Traffic/Road signs
    2. Overhanging trees/shrubs
    3. Noise nuisance
    4. Hazardous parking
    5. Storm sewer leaking/blockage
    6. Water leaking on roadway
    7. Loose/protruding manhole cover
25. Brief Description (or other problem not listed)
27. Location of Problem
    Please list address as needed
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