Report Mailbox Damage

This form is for use by Town of Rutland residents who have had a mailbox damaged on their property and would like to request replacement or reimbursement according to the guidelines in the Mailbox Damage Policy.

Company
This field is for validation purposes and should be left unchanged.
Policy Acknowledgement*
- I have read the Mailbox Damage Policy and the damage qualifies for replacement or reimbursement.
Date the damage occured*
MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Contact Number*
Email
Upload photos of the damage.
Drop files here or

Max. file size: 2 GB, Max. files: 5.
Please provide photos of the damage. Please include 1 photo showing the address of the property.
Describe the damage that occurred.*
I am requesting*
- Replacement
- Reimbursement