Service Turn On Request Form		  

* Fields marked with an asterisk (*) are required

Date of service activation must be at least 1 business day in advance
*NAME:
  
ADDRESS FOR SERVICE REQUEST MAILING ADDRESS (IF DIFFERENT)
*Street:   Name:

Apt./Suite:

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

Email
*Daytime Phone:  

Phone Call
*Email:  

No Thanks
Soc. Sec. #:  
Birthdate:  
 

DATE OF SERVICE ACTIVATION:

Date 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.


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

FAX: 859-578-3668



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