4 Way Ranch Service Request

4 Way Ranch Service Request
Instructions: Please complete this application in its entirety, once you submit an email will go to Amber.H@WSDistricts.co. Your Social Security Number (SSN) will be used for identification purposes. Applications for utility service are typically processed within five (3) business days from the day of receipt. You will have the ability to download a copy of this form once submitted. Denied applications will have three (3) business days to complete application requirements. You may also apply for service by calling 719- 447-1777. If you do not wish to provide your SSN, we will take your application at our office location at 614 N Tejon St., Colorado Springs, CO 80903. It is the tenant's responsibility to notify the District Manager to disconnect service when moving from this location.
*Check one of the following: *

Rental Property Commercial Property Owner Occupied
Property/ Owner(s) Information
Name *

*First Name *Legal Last Name
*Social Security Number (last four digits) *
*Date of Birth *

Month Day Year
Date
Property Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Requested Service Start Date *

Month Day Year
Date
Phone Number *
Please enter a valid phone number.
Email: *
example@example.com
Would you like to receive bills via e-mail? *

Yes No
Mailing Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
*Previous Address
Name of Landlord/ Property Manager (Printed, if Rental)
Landlord/ Property Manager/ Owner Signature

Clear

Emergency Contact Information
Name *
Phone Number *
Service Request *

□ Transfer of Ownership Account - $250 □ Transfer of Rental Account - $250 □ Meter Turn off/on - $50/ each time □ Disconection of Service - $150 □ New Tap Fee - $8,000/ SFE □ Other ( Please Explain)
I hereby certify that I have read the information on this form and understand its contents, and that the statements I have made are accurate to the best of my knowledge.
Applicant Signature:

Clear
Date: *

Month Day Year
Date
If you choose to email your application, you willingly accept all risks related to intercept, misaddressed, misdelivered, or otherwise unsecured transmissions.

.
Office Use Only:
Account Number:
Approved Date:

Month Day Year
Date
Notes:
Should be Empty:

4 Way Ranch Service Request

Property/ Owner(s) Information

Emergency Contact Information

Office Use Only: