BHMD Service Request Form

Service Request Form

Bradley Heights Metropolitan District: WSDM, LLC. 614 North Tejon Street Colorado Springs, CO 80903
Instructions: Please complete this application in its entirety and email to brenda.j@wsdistricts.co. 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. You call the office at 719-447-1777, for assistance. 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 PropertyCommercial PropertyOwner Occupied
Property/Owner(s) Information
Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Closing Move-in Date

MonthDayYear
Date
Name of Landlord/Property Manager

First NameLast Name
*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
Email
example@example.com
Landlord Property Manager Owner Signature

Clear
Phone Number*
Please enter a valid phone number.
Resident Information
Legal First and Last Name*

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

MonthDayYear
Date
Phone Number*
Previous Address*
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Third-Party Notification
I authorize the District Manager to send a duplicate Notice of Late payment to the Landlord/ Property Manager
Customer Signature

Clear
Emergency Contact

(residing in the United States, over the age of 18)
Name
Phone Number
Please enter a valid phone number.
Service Request
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
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. 8:00 a.m. to 5:00 p.m.
Address: 614 North Tejon St. Colorado Springs, CO 80903
For Office Use Only

Do not fill in these last three questions
Account Number
Approved Date

MonthDayYear
Date
Notes
Should be Empty:

Service Request Form

Property/Owner(s) Information

Resident Information

Third-Party Notification

Emergency Contact

Service Request

For Office Use Only