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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.
18. Upload File:
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21. 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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23. 1. Receive an email copy of this form.
24. Email address

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