Service Request Form

Service Request Form

Saddlehorn Ranch Metropolitan District (SHRMD) District Manager: WSDM, 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. Incomplete forms will result in application denial. If you have questions or concerns, please call the office at 719-447-1777 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 when moving from this location.
Check one of the following:*

ConstructionResidential
Property/Owner(s) Information
Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requested Service Start/ Stop Date

MonthDayYear
Date
Name of Landlord/ Property Manager (Printed)
Email
example@example.com
Please indicate if you would like your bills sent to the email you provide. Doing so, you will not receive a paper bill in the mail.*

YesNo
Landlord/Property Manager/ Owner Signature

Clear
Contact Phone Number
Please enter a valid phone number.
Resident Information
Name*

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

MonthDayYear
Date
Phone Number*
Previous Mailing Address*
Mailing Address (if different from service address)*
Third Party Notification
I authorize the District Manager to send a duplicate Notice of Late payment to the Landlord/ Property Manager

Clear
Emergency Contact (residing in the United States, over the age of 18)
Name
Phone Number ( )
Service Request*

□ Transfer of Ownership Account - $250□ Water Meter Turn off/on - $50 each after first□ Disconection of Service - $150□ New Tap Fee - $25,000Trash ServiceOther
I hereby certify that I have read the information on this form and understand its contents, an I have made are accurate to the best of my knowledge. Applicant Signature

Clear
Date

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

Phone (719)447-1777 Customer Service: Mon. -Fri. 9:00 a.m. to 4:00 p.m. Address: 614 North Tejon St. Colorado Springs, CO 80903
For Office use only:

Do not fill in the next three questions
Account Number
Approved Date

MonthDayYear
Date
Notes
Should be Empty:

Service Request Form

Property/Owner(s) Information

Resident Information

Third Party Notification

For Office use only: