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Service Request Form

2. Please call 713-475-5555 if you would like to speak to a representative in the Mayor's Action Line.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email Address*
16. Location & Service Request*
    Enter the location of the request and a description of the problem in the box below. You must include the street name, address or nearest cross streets of the location in order for us to assist you. (Example: Abandoned red Ford Explorer license XYZ123 leaking oil. The vehicle is located in front of 5555 Alpha St. The Explorer has been at this location for two weeks.)
18. Please submit any files (jpg, pdf, doc, etc.) related to your service request.
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field