Beverly Hills Mutual Water Company Service Request Form

Beverly Hills Mutual Water Company Service Request Form

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 Water Manager to disconnect service when moving from this location.
*Check one of the following:*

Rental PropertyCommercial PropertyOwner Occupied
Property/ Owner(s) Information
Name*

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

MonthDayYear
Date
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requested Service Start Date*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Would you like to receive bills via e-mail?*

YesNo
Email:
example@example.com
is you mailing address the same as the property address?*

YesNo
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Landlord/ Property Manager (Printed, if Rental)
Landlord/ Property Manager/ Owner Signature

Clear

Beverly Hills Mutual Water Company Service Request Form

Property/ Owner(s) Information

Emergency Contact Information

Office Use Only: