New Customer/ Final Bill Request

Shawnee Consolidate RWD1

150 W 9th St Auburn, Ks 66402

conrwd1@conrwd1.kscoxmail.com
(785) 256-2903

shawneeconrwd1.krwa.net
This form is used to request a Start or End to service. If you are new to the district we will use this information to setup your account for future billing. If you are moving out of the district we will use this to initiate a FINAL BILL.
Start / End of service date:*

MonthDayYear
Date
Select One*

Customer Details:
Full Name*

First NameLast Name
Phone Number*
E-mail
example@example.com
Service ID/Account #/Benefit #
Found on Billing Statement
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preference for Receiving Statements

Same as service addressUse a different Mailing addressEmail Address for Billing
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Seller/Landlord/Property Manager

First NameLast Name
Seller/Landlord/Property Manager Contact Number
Please enter a valid phone number.
Forwarding Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: