Work Order Request Form for the Town of Berwick
Please fill out this comprehensive form to submit a work order request for the Berwick Electric Commission or Public Works Departments.
Requester Full Name
*
First Name
Last Name
Requester Email Address
*
example@example.com
Requester Phone Number
*
Please enter a valid phone number.
Department
*
Please Select
Berwick Electric Commission
Public Works Department
Type of Work Request
*
Please Select
Electrical Repair
Lighting Maintenance
Power Outage
Tree Trimming or Removal
Road Repair
Sidewalk Repair
Drainage Issue
Snow Removal
Sewage System Issue
Public Facility Repair
Signage Maintenance
Storm Damage Cleanup
Other
Detailed Description of the Issue or Request
*
Location of the Issue or Request (Address)
*
Address
Close to which landmark
Priority Level
*
Please Select
Low
Medium
High
Emergency
Additional Comments or Special Instructions
Upload a photo.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Requester Signature
*
Unique Reference Number
Terms and Conditions
*
Submit Work Order Request
Submit Work Order Request
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