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2. Name (Exactly as Is Appears on Your Valid State-Issued ID)*
4. Email Address (If Applicable)
6. Best Contact Number*
8. Service Address to Connect*
10. Mailing Address*
12. Service Connection Date Desired*
    Service Connection Date Desired

    (Excluding weekends/holidays. Submissions after 3 pm will need to be scheduled for the following business day).

14. Additional Comments

16. Upload: Residential Application (PDF), Aplicación Residencial Española (PDF), / Commercial Application (PDF), and Rental Agreement.

18. Upload Residential Application*
19. Upload Commercial Application *
20. Upload Rental Agreement/Deed-Purchase Contract*
22. Consent *

    1. I Agree

    A Customer Service Representative will contact you at the number or email provided if any other documentation or payment is required.

    I acknowledge the above-stated information is correct.

    If you need to make changes to your submitted form, contact our office immediately at 620-276-1100. Fees may apply if you wish to cancel this request after it has been processed.

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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field