Service Turn On Request Form

* These fields must be completed.
*NAME:
   
ADDRESS FOR SERVICE REQUEST MAILING ADDRESS (IF DIFFERENT)
*Street: Name:

Apt./Suite:

 Street:
*City: Apt./Suite:
*Zip: City:
    State:
  Zip:
   
CONTACT INFORMATION CONFIRMATION?
*Phone:

Email
*Daytime Phone:

Phone Call
*Email:

No Thanks
Soc. Sec. #  
 
DATE OF SERVICE ACTIVATION: (Must be at least 1 business day in advance)
*MM/DD/YYYY   
    
COMMENTS
   
 

To turn on service someone must be present or you must sign and fax, mail,
or leave a copy of the NKWD Service Release Form at the service address.


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MAIL:
Attn: Customer Service
P.O. Box 18640
Erlanger, Kentucky 41018-0640

FAX: 859-578-5456