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.

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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