Citizen Service Request form template
See something that needs fixing? Report non-emergency issues like potholes, broken streetlights, graffiti, or illegal dumping. Add a photo and the location and your request is routed to the right department with a tracking number. You'll get updates as crews respond. For emergencies, always call your local emergency number instead.
Whatβs in the box
Pinpoint the spot
Add the address and a photo so crews find and fix the issue faster.
Track your request
Every report gets a tracking number and status updates by email.
Right department, first try
We route your report to the correct crew automatically based on the issue type.
Perfect for
- A driver reporting a dangerous pothole
- A walker reporting a streetlight that's out
- A resident flagging graffiti on a wall
- A neighbor reporting illegal dumping
Other templates you might like
Browse all β
Return / RMA Request
A guided, multi-step return flow β order, item, reason, and resolution β on a clean image-backed card.

SaaS Onboarding Survey
Onboard new users well β role, goal, and team size to personalise their first run.

IT Support Ticket
Internal IT requests β category, urgency, affected device, and a clear description.
Start with Citizen Service Request, ship today
Free forever for up to 1,000 submissions a month. No credit card.
Use this template