Mayberry Metro District Service Request

Mayberry Metropolitan District Service Request Form
c/o WSDM Managers, LLC

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.

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 (You must be residing in the United States and over the age of 18)
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.
Should be Empty:

Mayberry Metropolitan District Service Request Form