Mountain Vista Service Request Form

Mountain Vista Service Request Form
Mountain Vista Metropolitan District

c/o WSDM Managers, LLC

3204 N. Academy Blvd. Ste. 100 Colorado Springs, CO 80917

Instructions: Please complete this application in its entirety and it will be forwarded to our administrative team. Your Social Security Number (SSN) will be used for identification purposes. Applications for utility service are typically processed within five (5) business days from the day of receipt. Denied applications will have three (3) business days to complete application requirements, denials will occur for incomplete forms turned in. Please call the office at 719-447-1777 during regular business hours Monday through Friday, 8:00 a.m. to 5:00 p.m. for assistance. If you do not wish to provide your SSN, you may bring your application to our office location at 3204 N. Academy Blvd. Ste. 100, Colorado Springs, CO 80917. It is the tenant's responsibility to notify the District Manager to disconnect service when moving from this location. All accounts will be set up and remain with property owners, tenants or other third-party managers may be listed as contacts.
Check one of the following*

Rental PropertyOwner Occupied
Your Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Property/ Owner(s) Information
Service Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Contact Phone Number

Area CodePhone Number
Closing/Move in Date*

MonthDayYear
Date
Would you like to sign up for email billing?*

YesNo
Email
example@example.com
Name of Landlord/Property Manager/ Property Owner
Landlord/ Property Manager/ Owner Signature

Clear
Social Security Number (last four digits)*
Date of Birth*

MonthDayYear
Date
Previous Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your Mailing Address different from your property address?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (residing in the United States, over the age of 18)
Emergency Contact's Name*
Emergency Contact's Phone Number*

Area CodePhone Number
Service Request*

Transfer of Ownership AccountTransfer of Rental AccountOther
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*

MonthDayYear
Date
Account Number
Approved Date

MonthDayYear
Date
Notes
Should be Empty: