Service Request Form
Please fill out the form below to request services at our cyber cafe.
Client Information
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (0000000000).
Email Address
example@example.com
Preferred Date/Time for Service
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Services Requested
Please select the services you would like to request:
eCitizen Services
KRA Services (Filing of returns, KRA PIN Application e.t.c)
HELB & KUCCPS Services
Other
Additional Comments or Requests
0/1000
Submit
Should be Empty: