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* indicates a required field

2. First & Last Name*
4. Business Name*
6. Email
8. Business Location*
10. City

    Must be located in Citrus Heights.

11. State
12. Zip
14. Please select the quantity of signs you're requesting.*
    -- Select One --One (1)Two (2)
16. A limited number of pole mounts are available if needed. Would you like pole mount with your signs?*

    1. Yes
    2. No
18. Where do you plan to place these signs?*

    The City would like to know how your business plans to utilize these signs.

    1. Exterior Wall
    2. Parking Lot
    3. On or Near Dumpsters/Trash Receptacles
    4. Perimeter Fencing
    5. Adjacent to Security Cameras
20. By clicking this button, I understand that the City holds no liability for any illegal dumping activities that may occur. Signage does not guarantee a particular result. I acknowledge that any such actions are solely the responsibility of the individual or entity engaged in the illegal dumping, and the City bears no legal responsibility for the consequences thereof. City holds no liability related to the installation of the signage or any other harm or injury that could result from the signage.*

    1. I understand.
22. Sign Pick Up Instructions

    After completing this form, your reservation request will be sent to City staff. Signs will be available for pick up at City Hall's front office the next business day. 

    City Hall is open Monday through Friday from 8 a.m. to 4 p.m. We are closed for select holidays.

    Signs that are not picked up after five (5) business days will be made available for reservation again.

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

    This field is not part of the form submission.

25. Submit

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