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2. Please use this form to report your concerns about traffic in Londonderry. 

4. Name*
6. Address*
8. City
9. State
10. Zip Code
12. Phone Number
13. Email Address
15. My traffic concern is about:*
    -- Select One --speedingaccidentstraffic volumevisibilitypedestrian safetysignsstoplightshazards on the roadother
17. Other:*
19. Describe the location of your concern. Please be as specific as possible.*
21. Describe the issue in as much detail as possible.*
23. Did this issue occur on a specific date and time, or is it ongoing?*

    1. Specific date and time

    1. Ongoing
25. When?*
    When?

    When?
27. When do you most frequently observe the issue?*
29. Have you previously contacted the Town of Londonderry about this issue?*

    1. Yes

    1. No
31. If so, approximately when?*
33. Please upload any relevant images (max 3)
35. Would you like someone from the Town to reach out to you?*

    1. Yes

    1. No
37. Would you like this issue to be addressed at a future Traffic Safety Committee meeting?*

    1. Yes

    1. No
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field