ATCOG 9-1-1 Address Request Form

Select the structure's driveway location on the map below.

Click and drag the red pin to the location of the structure's driveway.
This will provide us with the latitude and longitude for your address request.
This step must be completed in order for our team to quickly provide an accurate address.

Select Structure Driveway Location (near where the driveway meets road)*

Tips:

When using zoom or pan on the map, the red pin will not automatically move. You must manually drag the pin so that it is within the map window.
To view satellite imagery, select the "Satellite" button in the top left corner of the map.
Use the scroll wheel on your mouse to zoom or use the + and - buttons on the lower right corner of the map. On a mobile device, you may also use the pinch-to-zoom gesture.
The map will automatically pan when the red pin is dragged near the edge of the visible map.

Your Name*

TitleFirst NameLast Name

Requestor Organization (if you are a representative of a corporation, agency, developer, etc.)

Organization Name (Optional)

Is the structure a residence?*

YesNo

Resident Name (if different than your name)

TitleFirst NameLast Name

Phone Number*

Enter your phone number.

Secondary Phone Number

If desired, enter a secondary phone number. (Optional)

Email*

Confirmation EmailPlease enter your email address. You will receive a confirmation message at this email address.

County*

Please select the county of the structure. If your county is not listed, contact the 9-1-1 addressing authority for your county.

Type of Request*

New StructureExisting StructureOther

Is this request for a cell site, cell phone tower, cellular base station, temporary COW/COLT, or similar telecommunications structure?*

YesNo

If you have a site plan or similar document upload it here. (OPTIONAL)

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Acceptable file types include: .PDF, .DOC, .DOCX, .XLS, .XLSX, .JPEG, .PNG, .TIFF, .DWG, .DXF, and .DGN

Are you a property developer, land developer, real estate agent, landowner (or acting on behalf of one) and requesting one or more addresses within the same development?*

YesNo

If you have a plat, site plan, or similar document upload it here. (OPTIONAL)

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Acceptable file types include: .PDF, .DOC, .DOCX, .XLS, .XLSX, .JPEG, .PNG, .TIFF, .DWG, .DXF, and .DGN

Is this request for a single address located within a subdivision, mobile home/RV park, apartment/condominium building, or multi-tenant structure?*

YesNoUnsure

Name of Subdivision, Mobile Home/RV Park, Apartment/Condominium, or Multi-Tenant Structure

Please enter location name. (Optional)

Lot Number

Please enter lot number. (Optional)

Block, Tract, and/or Phase Number

Please enter block, tract, and/or phase number. (Optional)

Other Identifying Number or Name

Please enter any other identifying number or name. (Optional)

Type of Structure*

Please select the closest matching type of structure.

Road Name*

Please enter the road name for the new structure. (This should be the street where the driveway will be located).

Cross Street Name (if applicable)

Please enter the closest cross street for the new structure. (If applicable)

Location Information for New Structures*

Previous/Existing Structure Address (if known)

Street Address

Street Address Line 2 (apartment, building, suite, unit, etc.)

City or Municipality

Post Code / ZIP Code

Previous Resident or Tenant Name (if known)

Please enter the name of the previous resident or tenant.

Location Information for Existing Structures*

Other Request*

Please provide a detailed description of the request.

(OPTIONAL) Comments, Information, or Other Details

If needed, enter any other comments or information. (Optional)

(OPTIONAL) If there are any images or documents that will assist in identifying your address request location, please upload them below. NOTE: Don't include any confidential or private information.

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Acceptable file types include: JPEG, PNG, TIFF, and PDF.

Please verify that you are human:*

$Ark-Tex Council of Governments 9-1-1 Program Logo$
Ark-Tex Council of Governments
PO Box 5307, Texarkana TX, 75505-5307

ATCOG 9-1-1 Address Request Form

Development Location Information

Structure Information