Affordable Connectivity Program Consumer Opt-In

Date of Birth:

*If required, a representative will contact you by phone to obtain the last four of your Social Security Number to complete enrollment.

I hereby opt-in to the Affordable Connectivity Program (ACP) and acknowledge that I am aware of the eligibility requirements for the Affordable Connectivity Program.
Accept

I acknowledge that the Affordable Connectivity Program is non-transferable and that the discount is limited to one discount per household, and I further certify that no other member of my household is receiving a benefit under the ACPAccept

I acknowledge that I have reviewed the available upload/download speeds for services offer by TWN Communications for the Affordable Connectivity Program.Accept

I acknowledge that due to the temporary nature of the program, the ACP benefit may be less than the full benefit during the final month of the program. Upon the conclusion of the benefit, my household will be subject to TWN Communication’s regular rates, terms, and conditions if my household continues to subscribe to TWN Communication’s broadband service.Accept

I consent to applying my ACP benefit to the broadband Internet access service I receive from TWN Communications.Accept

I consent to TWN Communications disclosing and/or transmitting any information required to the program Administrator for my participation in the program including but not limited to my name, my dependent’s name, date of birth, last 4 digits of social security number or Tribal Identification Number, address, telephone number, type of service, start date of service, termination of service date, ACP discount amount, eligible program, tribal benefit status, Lifeline Tribal Benefit, Linkup Service Date and Independent Economic Household certification date.
Accept

I consent to TWN Communications verifying my household’s broadband usage each month to enable TWN Communications to claim reimbursement for my program benefit each month.Accept

I acknowledge that if I cannot demonstrate eligibility, I will not be enrolled in the program by TWN Communications.Accept

I acknowledge that if TWN Communications has a reasonable basis to believe that I am no longer eligible to receive the ACP benefit, I will receive a notification of impending termination of my ACP benefit and will have 30 days following the date of such notice to demonstrate continued eligibility.Accept

I acknowledge that I may obtain ACP-supported broadband service from any participating provider of my choosing and that I can transfer the ACP Benefit to another provider at any time.Accept

I acknowledge that TWN may terminate and/or suspend my services after 90 days of nonpayment. Furthermore, I will not be required to pay early termination fees if I choose to terminate or modify my broadband service during my participation in the ACP, or upon receiving notice of the benefit ending.Accept

I acknowledge that my participation in the ACP does not relieve my obligations to adhere to TWN Communications posted rates, terms and conditions, or other rules and regulations or tariffs that govern the services I receive.Accept

I acknowledge that I am a current Lifeline customer and want to apply my ACP benefit to services with TWN.—Please choose an option—YesNo

I certify that:
(1)I have confirmed my eligibility for the Affordable Connectivity Program through the National Verifier.Accept

*

*Electronic Signature (eSignature): You consent and agree that your use of a keypad, mouse, or other device to select an item, button, icon, or similar act/action, or to otherwise provide TWN Communications; or in accessing or making any transactions regarding any document, agreement, acknowledgement, consent terms, disclosures, or conditions constitutes your signature, acceptance, and agreement as if signed by you in writing. Further, you agree that no certification authority or other third-party verification is necessary to validate your electronic signature; and that the lack of such certification or third-party verification will not in any way affect the enforceability of your signature or resulting contract between you and TWN Communications. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that your eSignature executed in conjunction with the electronic submission of your form will be legally binding and such transaction will be considered authorized by you.