Forms • City of Azusa • CivicEngage

Traffic Signal Light Out

Leave This Blank:

Where is the traffic signal located?*

Describe the issue with the traffic signal.*

	Traffic Signal Out
	Traffic Signal Flickers On/Off

	Traffic Signal Does Not Change
	Other:

Additional information regarding traffic signal issue:

What is your contact information if you need to be reached for further clarification of the issue.*

Name:

Contact Phone Number:*

* indicates required fields.