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  • 1. Type of Message
  • 2. Choose the option that describes who this request pertains to
  • 3. Choose the option that most closely describes your request
  • 4. Describe your service request in as much detail as possible
  • example: Pothole in the middle of the road
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  • 5. Enter the address/location for the service request
  • Street Address (include unit/apt no. as it applies)
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  • City
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  • If you do not have an exact address for the problem, please describe location as clearly as possible
Response Requested
First NameLast Name
Home PhoneMobile Phone
eMail



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We enhance the quality of life for people throughout Polk County
The Polk County Board of County Commissioners is an Equal Opportunity/Affirmative Action Employer
Polk County Board of County Commissioners | 330 West Church Street | P.O. Box 9005 | Bartow, FL 33830 | 863.534.6000