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 Pothole Report Form 

Use this form to report a pothole in a public street or highway. Please describe the location of the pothole by reference to street names, intersections and clearly visible landmarks.

First Name:
 *
Last Name:
 *
Email Address:
 *
Address:
City:
State:
Zip Code:
Telephone number
Location of the Pothole:
 *
Security code:
 *
Do not enter anything in this field:

* indicates a required field
 

Township of Pemberton
500 Pemberton-Browns Mills Road
Pemberton, New Jersey 08068-1539
Phone: 609.894.8201
Fax: 609.894.2703

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