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Magnet Wireless, Inc. Transfer Consent

SSN DOB

What Type Of Government Assistance You Are Receiving?

Food Stamps

Medicaid

SSI

WIC

Fedral Public Housing Assitance

Low Income

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 10 GB data, unlimited talk, and text.
I understand if i use this sim card maximum three months i might be able to recieve a tablet from this company if i eligible for it.
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.
I authorize Magnet Wireless Inc. to enroll me for the first time and, if needed, transfer my existing records instead of treating me as a new customer. Additionally, I consent to Magnet Wireless Inc. managing my account and handling any necessary administrative processes to facilitate my enrollment and ongoing service. I understand that this may include updating my personal information and service preferences as required.

Please check the appropriate statement if one of the exceptions below applies to your household:

You believe that an internet company transferred your ACP benefit without providing you with the required disclosures and/or obtaining your consent to transfer your ACP benefit.

Your household’s internet company stopped operating or failed to provide internet service. or

You moved to a location outside of your current internet company’s service area.

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

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July 6, 2024 5:57 pm -06

Magnet Wireless, Inc. Transfer Consent Uploaded by magnet wireless - info@magnetwireless.co IP 182.191.93.80