Keyes Community Services District
5601 7th Street
P O Box 699
Keyes, Ca 95328
209-668-8341

First Name (required)

Middle Name (required)

Last Name (required)

Service Address (required)

Mailing Address (required)

Email (required)

Cell Phone # (required)

Home Phone # (required)

Date Service Turned On (required)

Name of Employer (required)

Phone Number of Employer (required)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

There was a problem saving your submission. Please try again later.

Please wait while your submission is being saved...

Submitting...Submit

Thank you, your submission has been received.