Service Request

Service Request
Mayberry Metropolitan District District Manager: WSDM, LLC

614 North Tejon Street Colorado Springs, CO 80903

Instructions: Please complete this application in its entirety and email to Amber.H@WSDistricts.co Your Social Security Number (SSN) will be used for identification purposes. Applications for 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 may 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. All accounts will be set up and remain with property owners, tenants or other third party managers may be listed as contacts.
Property/ Owner(s) Information *Service Address
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Closing Move in Date*

MonthDayYear
Date
Receive Email Billing?

YesNo
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Name of Landlord Property Manager Owner Printed
Property Owner Name*

First NameLegal Last Name
Last Four of S.S.N.*
Date of Birth*

MonthDayYear
Date
Previous 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
Customer Signature

Clear
Emergency Contact (residing in the United States, over the age of 18) Name
Name*
Phone Number*
Please enter a valid phone number.
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
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