This form is only for normal shut off requests. If it is an emergency, please call (620) 225-8111 during regular business hours (Monday - Friday, 8:00 am - 5:00 pm). If after hours, please call our After Hours Emergency Phone - (620) 255-9669.

Last Name*

First Name:*

Physical Address:*

Account Number (required):*

Phone Number:

E-mail Address:*

Date your water service is to be turned off*

Your request will be completed by the end of the next business day.

You will receive a final bill from the time of your last meter reading to the date you requested that your water be turned off.

Please complete the fields below as to where we should mail your final bill.

Last Name*

First Name:*

Mailing Address:*

City:*

State:*

Zip Code (5 digit):*