WGRMD Service Request Form - updated 2024.03.07

Service Request

Wildgrass at Rockrimmon Metropolitan District

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 to disconnect service when moving from this location.

Property Owner(s) Information:

*Owner Name (first & last):*

Additional Owner Name (first & last) - if applicable:*

*Property / Service Address:*

*Closing Purchase Date*

Date

*Owner Phone Number*

*Owner Email Address*

example@example.com

*Social Security Number (last four digits)*

Reminder, if you prefer not to provide the last four digits of your social security number, you may opt to visit the Management office in-person to verify your identity by showing a government issued ID. To complete the application and download a PDF version, which can be presented in-person, please enter 0000.

*Date of Birth*

Date

Owner's Mailing Address (if different from service address)

*Owner's Previous Address:*

*Is this property occupied by the Property Owner?*

Yes, Owner occupied.No, leased to aTenant.

Tenant(s) Information:

Tenant Name (first & last)

Additional Tenant Name (first & last) - if applicable

Lease / Move-In Date

Date

I would like the tenant to receive a copy of important District information & Notices sent.

Yes, copy my Tenant.No, I will forward applicable information.

Tenant Phone Number

Tenant Email Address

example@example.com

Have you provided all Governing Documents, Covenants, Design Guidelines, Rules and Regulations to your Tenant(s)?

Yes, they are familiar with the Governing Documents and have been provided copies.No, I accept responsibility for violations and fines that may occur due to lack of information.

*Is this property managed by a Property Manager or other third-party?*

Yes, I have a Manager.No, I oversee the Tenant(s) directly.

Property Manager(s) Information:

Management Company Name:

Management Company Office Address:

Management Point of Contact Name:

Point of Contact Phone Number:

Point of Contact Email Address:

example@example.com

I would like the Manager to receive a copy of important District information or notices sent.

Yes, copy my Manager.No, I will forward applicable information.

Emergency Contact (residing in the United States and over the age of 18):

Full Name

Phone Number

*Service Requested:*

Transfer of Service (resale / new Owner)Establish New Service (new construction)Other (please explain)

Please Explain

I hereby certify that I have read the information on this form and understand its contents, and that the statements I have made herein are accurate and true to the best of my knowledge.

*Applicant Signature*

*Date*

Date

Should you choose to download and email your completed application, you willingly accept all risks related to intercept, misaddressed, misdelivered or otherwise unsecured transmissions.

*Denotes required field