Greenstreet Request Form

Personal Contact Information
All fields are required unless otherwise specified.
*First Name:
Middle Initial (optional):
*Last Name:
*Address Line 1:
Address Line 2 (optional):
*City:
*State:
*Zip Code:
*Daytime Phone Number:
*Email Address:
Proposed Greenstreet Location Information
All fields are required unless otherwise specified.
*Street address of the building nearest to the site:
*Intersecting Streets:
*Borough:
*Type of street property (traffic median/triangle/other (explain)):
*Does site have overhead utility lines?: Yes No
*Does site contain a fire hydrant?: Yes No
*Is site adjacent to a bus stop? : Yes No
*Additional Comments:
Please provide as much information as possible with regards to the specific location. Details about the quality of the site, the surrounding environment, current uses of the property, etc. are all welcomed.
Upload picture of the site (optional):

Personal Contact Information