Form Center

2. The City of Centralia is dedicated to providing quality customer service. This form was created to allow the online reporting of non-emergency Public Works issues. Please be as detailed as possible when filling out the form. For more information view the reporting an emergency Public Works page.

4. Please Enter a Brief Description*
6. Enter the Street Number and Name*
8. Your Name
10. Would you like to be contacted regarding this request?*
    -- Select One --YesNo
12. Phone Number
14. Email
16. Security

    Forms available on this website are not encrypted during transmission. Please do not send private information.

18. Disclosure of Information

    As a public agency, the City of Centralia is governed by public records laws. Any information received through the use of our website via email or online forms is subject to disclosure. Please contact the City Clerk for more information.

Leave This Blank:


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