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CleanIt! Form

2. 

4. This form is for public areas only. If there is a concern with private property please complete the FixIT form.

6. Please state the location you are reporting:

   If possible please include the address number and street. If not possible, use location descriptors and landmarks.

8. Please describe the area, amount of litter and type of litter:

10. Will any special equipment be required to remove all of the litter?
    -- Select One --YesNo

12. If yes, what do you recommend is needed? (Large trailer, shovels, a large group, etc.)

14. Have you reported this area before?
    -- Select One --YesNo

16. If you would like to receive an update status on the area you've reported, please complete the contact form below.

    If you would like to receive an update status on the area you've reported, please complete the contact form below.

20. Name

21. Email Address

23. Address

25. City

26. State

27. Zip Code

29. Phone Number

30. Fax Number

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field