Form Center

2. 
4. City of Jenks
   PO Box 2007, 211 N Elm St Jenks OK, 74037
   918-299-5883
6. Do you need storm cleanup assistance?
   
   If you are elderly or physically not able to cleanup debris (i.e. tree limbs & trash), please fill out this form & The City will coordinate volunteers to assist you.
8. First and Last Name*
9. Email Address*
11. Address of Property*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
19. Comments
21. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your form will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field