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KANSAS RESIDENTIAL SERVICE APPLICATION

Thank you for choosing MoKan Dial.  All Fields highlighted in (*) are required fields.


First Name*

Middle Name*

Last Name*

Spouse Name

Mailing address*

911 address*

Contact number where you can be reached*

Directory Listing
YESNO($2.00 PER MONTH FOR UNLISTED NUMBER)

List As

Place of Employment

Address

Nearest Relative

Address

Long Distance Requested
YESNO

Customer Proprietary Network Information (CPNI)
CPNI Password

Additional Contacts

Shared Secret Questions:
What is your favorite color?

What city were you born in?

Directions to Home

BASIC LOCAL SERVICE PER LINE PER MONTH $27.18 (CITY) $26.57 (RURAL)

Email*



MOKAN COMMUNICATIONS

Come By Our Office:
112 South Broadway
Louisburg, KS 66053

Call Us:
Office: (913) 837-2219
Toll Free: (800) 758-1715
Fax: (913) 837-5108
Trouble Reporting:
(913) 837-2222