2. Power Outage
   If there is a power outage, please contact Potomac Edison.
4. Contact Information
6. First Name*
7. Last Name*
9. Address1*
11. City*
13. Phone Number*
14. Email Address
16. Signal / Light Information
18. Complaint Applies to*

    1. Street Light

    1. Traffic Light
20. Location Address or Cross Streets*
22. Brief Description of Problem*
24. Pole Number
    If known, identify pole number. This will assist in identifying the light in a more efficient manner.
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field