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2. Brazos County Road and Bridge Work Order Request
4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*
10. Location in Need of Repair*
    Please leave an address, intersection, or description of where the area needing repair is located.
11. File Upload
    Please upload a picture or file regarding the issue if possible.
13. Description of Location to Be Repaired*
    Please give us a brief description of the issue you would like to have repaired. If you leave your phone number we will contact you if we need further information.
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit Submit and Print

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