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Magnet Wireless, Inc. Joining Form


       

   

SSN         DOB    

What Type Of Government Assistance You Are Receiving?

Address

   

     

 

  • I confirm my legal age and authority over Internet service decisions, including changing providers.
  • I've chosen Magnetwireless, Inc. as my ACP Benefit Provider, knowing the government will provide $30.00 to cover sending a SIM card with 5 GB data, unlimited talk, and text.
  • I anticipate receiving the SIM card within a week after endorsing this form.
  • I authorize Magnetwireless, Inc. to enroll me for the first time and, if needed, transfer my existing records instead of treating me as a new customer
  • The scope of this authorization pertains solely to ACP verification. Magnetwireless, Inc. is granted access to requisite records for the purpose of confirming eligibility.
  • Understanding that the ACP entails a limited-duration subsidy for reducing internet charges, I acknowledge that standard rates will apply upon the program's conclusion, should I continue my subscription.
  • Affirming that my annual household income adheres to the Federal Poverty Guidelines, staying within 200% of the specified value, I attest to its accuracy.
  • In the event of address changes, I commit to notifying Magnetwireless, Inc. within 30 days. Equally, I acknowledge the requirement to communicate any changes in eligibility status promptly.
  • I recognize that households are entitled to a singular ACP benefit. Even if changing providers, only one device (Tablet) will be provided.
  • I provide explicit consent for the utilization of the information I've submitted exclusively for ACP benefits application. Per legal requirements, I accept the potential sharing of benefits information if mandated by state or Tribal regulations.
  • All responses provided herein are truthful and accurate. I am well aware that furnishing false information could lead to legal repercussions, including fines.

 

By endorsing this form, I confirm my thorough understanding and agreement.

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Document name: Magnet Wireless, Inc. Joining Form
lock iconUnique Document ID: 10be70aeadd8c873cd1302f688522158a80bdaf4
Timestamp Audit
November 27, 2023 5:14 pm -05Magnet Wireless, Inc. Joining Form Uploaded by James Alex - sales1@mangnetwireless.com IP 101.50.88.176