Required fields are marked with asterisks (*)

Name Bank Submission Form

Thank you for your interest in submitting a name for consideration in naming streets and facilities in the Town of Milton.

Please be aware that written consent will be requested for all names being proposed for any individuals, families, organizations or businesses, either living or in memoriam.

Personal information contained on this form is collected under the authority of the Municipal Act, 2000 and will be used to respond to your request. Questions about this collection should be directed to Development Services Administration, 905-878-7252 extension 2398.

Contact Information

First Name:

Last Name

Email Address:

Phone number:

Street Address:

Town

Postal Code:

Form Builder

Name Bank Submission Form

Contact Information