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2. Contact Information
4. Name*
6. Address*
8. Address 2
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address*
19. Details*
    Describe in as much detail as possible the location of the pothole.
23. Understanding of Local Report*

    I understand that I'm reporting a pothole on a local Westland road and that reporting potholes located on Wayne County roads via this form will not be reported to the County.

    1. I understand
27. Email Address to Receive a Copy of Your Submission
    To receive a copy of your submission, please fill out your email address before submitting.
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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