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2. First Name*

3. Last Name*

5. Address

7. City

8. State

9. Zip Code

11. Phone*

13. Phone 2

15. Email Address*

17. Comments

    Please use as much space as you need to give us your comments on how The Town of Northlake can do a better job of serving you.

19. Please check all that apply.

    1. I prefer to be contacted by email.
    2. I prefer to be contacted by phone.
    3. It is OK to contact me in the evening.
    4. It is OK to contact me in the morning.

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20. 1. Receive an email copy of this form.
21. Email address

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22. Submit

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