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Magnet Wireless, Inc. Joining Form

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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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November 27, 2023 5:16 pm -06

Magnet Wireless, Inc. Joining Form Uploaded by David Warner - sales2@mangnetwireless.com IP 101.50.88.176