Eligibility Check

Legal First Name

Legal Last Name

Date of Birth

You must be 18 years or older to apply for service

Last 4 digits of SSN

Who receives government assistance?

Applicant qualified through a Child or Dependent

Qualifying Program

Address 1

Address 2

City

State

Zip

Phone Number

Email

Account Password

Terms and Conditions

Review the Government Program Agreements to get this FREE Monthly Cell Phone Service

I participate in one of the designated qualifying programs for the Affordable Connectivity Program (ACP) benefit or have income at or below the level specified by the Federal Poverty Guidelines for the ACP benefit, and will provide documentation of eligibility, if required to do so. I affirm and understand that the ACP is a federal government program which reduces the customer’s broadband internet access service bill and depends on government funds.

I understand that I must notify the company within 30 days if I am no longer a participant or no longer qualify for the ACP benefit. If I, or another member of my household, obtains ACP service from another carrier, or, for any other reason, I no longer qualify for the ACP benefit. I understand that I may independently obtain service for the ACP benefit from any provider.

I confirm that I have read and understand the disclosures, read and agree with the authorizations, and want to OPT-IN to the ACP benefit discounted broadband service. I understand I may be required to recertify, or reverify my continued eligibility for the ACP benefit at any time and failure to do so will result in the termination of my ACP benefit. I am required to use the service at least once every 30 days, or my service will be suspended, subject to a 15-day period which I may use the service or state that I want to continue receiving their service.

If I change my address, I will provide my new address within 30 days. I acknowledge and consent to receiving calls, emails, and/or text messages on any telephone number associated with my account, including wireless and other personal telephone numbers that could result in charges to me. I give express consent to be contacted to validate my eligibility for, or desire to participate in, offers and other products and services via email, telephone, or text message. Text messaging and data rates may apply. Consent for calls and texts is optional and can be revoked at any time. Opting out will not affect the company's ability to contact me with messages regarding my service functionality via the methods listed herein. For more information, see our Terms and Conditions and Privacy Policy. I waive all legal rights, if any, if I am contacted by them in any manner as part of the application, or if I receive service.

My household will receive only one ACP benefit, and to the best of my knowledge, my household and/or spouse does not already receive the ACP benefit. I do not share living expenses and income with any other adult who currently resides at my address and is receiving the ACP benefit.

The information contained in this application and agreement is true and accurate to the best of my knowledge, and I acknowledge that providing false or fraudulent information to obtain benefits is punishable by law. I authorize to collect, use, share, and retain my personal information, including, but not limited to, information required for the purpose of establishing eligibility for and enrolling in the ACP, and including, but not limited to, full name, full residential address, date of birth, last four digits of social security number, telephone number, eligibility criteria and status, the date on which the service discount was initiated and if applicable, terminated. The following information is needed for the proper administration of the ACP, the amount of support required for my account and how I qualified for the program. Failure to provide consent will result in me being denied the ACP service benefit.

I authorize (1) access any records to verify my statements herein; (2) to confirm my continued eligibility for the ACP benefit; (3) to update my address to a proper format; (4) to provide any and all of the information related to my account including, but not limited to, my name and address to the Universal Service Administrative Company (USAC), and/or its agents for the purpose of verifying that I only receive one ACP benefit; and (5) authorize social service agency representatives to discuss with and/or provide information verifying my participation in a government benefit program that qualifies me for assistance. I agree that any state, local, Tribal government, school or school district, may share information about my receipt of benefits that would establish eligibility for the ACP service.

Under penalty of perjury and under title 18 U.S.C. § 1621, whoever willfully states as true any material matter which he does not believe to be true in a statement under penalty of perjury, is guilty of perjury and shall, except as otherwise expressly provided by law, be fined or imprisoned not more than five years, or both and can be barred from the program.