2. City of Rogers Permitting Portal
   Help Request/Feedback

   Use this form to request assistance using the Portal (registration, application submission). For assistance with other Planning questions, please call (479) 621-1186.

4. First Name
5. Last Name
7. Request Topic*
   -- Select One --RegistrationApplication SubmittalFeedback/CommentOther

   What do you need assistance with?
8. Was your portal application submitted?

   1. Yes
   2. No
   3. Not sure/Did not create application

   Indicate whether your portal request was submitted.
10. Help Request Detail / Comment
    What do you need help with? What is your feedback? Describe the issue with as much detail as necessary.
14. How should we contact you?

    1. Phone
    2. Email
    3. No response required
15. Your preferred contact phone number
    Please provide your preferred phone number for use with this help request
16. Your preferred email
    Please provide your preferred email for use with this help request
18. Note: The above contact information will not alter any information you currently have on file. It will only be used for this help request.
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field