Address Request Form

Complete the form below to request an address. Please note that fields marked with an (*) are required. This request may take up to 10 business days. If you have questions, please call 205-439-6911.

Applicant Name

The first and last name of the person who is requesting an address

First Name

Last Name

Applicant Street Address

Applicant City

Applicant State

Applicant Zip

Applicant Phone Number

(###)

###

####

Applicant Email

Is this a new street?

Yes

Existing Street or Road Name

Enter the street or road name that the new address will be on

City/Municipality/Area

Parcel Number

Closest Known Address

Type of Structure to be Addressed

Is there currently a structure on the property?

Yes

Shared Driveway? If yes, please enter the address for the existing structure below.

Yes

Shared Driveway Structure's Address

Additional Information