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2. First Name
   Please type your first name.
3. Last Name
   Please type your last name.
5. Street Number
   Street Number
6. Street Name
   Street Name
7. Street Type
   Street Type
8. Apt #
   Apt. Number
10. City

    City

11. State

    State

12. Zip

    Zip Code

14. Which Bus Service Does Your Comment Apply To?*
    -- Select One --V-LineChicaGO DashBoth V-Line and Dash

    Please select which bus service your comment applies to: V-Line, ChicaGO Dash or Both.
16. Comment*
    Please describe your comment in detail here.
18. Email Address
    Insert your email address here.
20. If you require assistance completing this form or need an alternate format, please contact Attn: Transportation Department, City Hall, 166 Lincolnway, Valparaiso, IN 46383. (219)462-1161
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

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