City of Fairfax, VA

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Online Commendation or Complaint

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Please correct the fields below:

Please correct the field(s) marked in red below:

General Information

I am writing about a

*

I am writing about a

First Name:

*

First Name:

Last Name:

*

Last Name:

Address:

*

Address:

City:

*

City:

State:

*

State:

Zip Code:

*

Zip Code:

So that we may contact you

Home Phone Number:

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Home Phone Number:

Work Phone Number:

E-Mail Address: (Please provide email address if you'd like to be contacted via email. )

Additional Information

Name of the Officer/Employee Involved:

Location of the Incident: (Address, Intersection Names, Business Names)

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Location of the Incident: (Address, Intersection Names, Business Names)

Date of Incident:

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Date of Incident:

Time of Incident:

Nature of the Incident:

Please Describe What Occurred:

*

Please Describe What Occurred:

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