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Traffic Complaint Form

  1. This form is in place to allow community members the opportunity to alert the Purcellville Police Department to potential traffic problems. If you have a reoccurring traffic problem in your neighborhood that you feel needs attention you can complete this Form or call 540-338-7422 to report it. Information submitted on this form will be sent via email to the following PPD staff members: Deputy Chief, Operations Lieutenant, and the Administrative Lieutenant.
  2. Contact Information
  3. Complaint Information
  4. Please be aware that information submitted through the Town of Purcellville Government website is considered a Public Record under the Virginia Public Records Act, and may be subject to release by the Town in response to a request made under the Virginia Freedom of Information Act.
  5. Do not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services.
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  7. This field is not part of the form submission.