Submit A Question or Concern Form

Please fill in the form below with all required information, then hit the green SUBMIT button to email your question or concern to the Village of Cankton. Thank you.
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Date REQUIRED Please fill out this field. Please enter a date.
- Type Your Question or Concern REQUIRED
  Please type a BRIEF message below with details about your question or concern.
  Please fill out this field.
- A receipt confirmation will be sent to this email address. Please enter an email address.
- By hitting the SUBMIT button below, your question or concern will be sent to an email address for the Village of Cankton. We will get back with you as soon as possible with a reply or for additional information.
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