Affordable Connectivity Program (ACP) Authorization Form - On Qualifying Tribal Lands

The plan described above maximize your ACP benefit at no cost to you. Customers who choose a more expensive plan will be charged the balance after the ACP benefit has been deducted from that plan. Please visit us at mycellularone.com to see all of our ACP plans.

• Has a total income at or below 200% of the Federal Poverty Guidelines

Or at least one member of the household:

• Qualifies for the FCC’s Lifeline program;
• Receives benefits under the free and reduced-price school lunch program or the school breakfast program;

• Received a Federal Pell Grant; or
• Receives assistance through the special supplemental nutrition program for women, infants and children (WIC)

Additional Terms: The Affordable Connectivity Program (ACP) is a government program that reduces customers’ broadband internet access service bills. By law, the ACP is only available for one account per household. You may obtain broadband service from any participating ACP provider and may transfer your ACP benefit to another qualified ACP provider of your choosing once per month. Must be 18 years of age or older. If you elect to participate in the ACP through Cellular One, we will apply your ACP benefit to reduce the cost of your plan. A plan must contain a data component to be eligible for the ACP. If you currently receive an ACP benefit from another provider, you authorize the transfer of your ACP benefit from your current provider to Cellular One. You understand that transferring your ACP benefit to Cellular One means that you may be required to pay or lose service with your current provider. If you qualify and elect to participate in the ACP through Cellular One, we will subtract the benefit amount from the total cost of your plan. Qualifying participants on tribal lands will receive an ACP benefit up to $75 per month; qualifying participants on non-tribal lands will receive up to $30 per month. If you do not use the total benefit awarded you will not receive cash back or credit for other services or products. For more information regarding your benefits please visit: https://www.ACPBenefit.org. HAC phones are available upon request. Data speeds are not guaranteed. Data is good for a 30-day billing cycle. The data provided through this plan is able to be “tethered” to other devices. Any unused data does not carry over to the next 30-day period. Other restrictions apply. For more information regarding your benefits please visit: www.ACPBenefit.org or call Customer Care at (800) 730-2351. Your Cellular One Plan remains subject to Cellular One’s excessive use, disproportionate roaming and Fair Use Policies. See www.mycellularone.com.

For more information regarding your benefits please visit: https://www.ACPBenefit.org. Full terms and conditions will be posted at www.mycellularone.com when the ACP begins. HAC phones are available upon request.

(A) You will be transferring your affordable connectivity program benefit to Cellular One;

(B) The effect of the transfer is that your ACP benefit will be applied to Cellular One’s service and will no longer be applied to service retained from your previous provider;

(C) You may be subject to your previous provider's undiscounted rates as a result of the transfer if you elect to maintain service from your previous provider; and

(D) You are limited to one ACP benefit transfer transaction per service month, with limited exceptions for situations where you seek to reverse an unwanted transfer or are unable to receive service from a specific provider.