Disclosure of Affordable Connectivity Benefits Transfer Disclosure of Affordable Connectivity Benefit Transfer I hereby consent and authorize the transfer of my Affordable Connectivity Program (ACP) benefits to ATC Communications (transfer-in provider) from my previous Internet Service Provider (transfer-out provider): • I acknowledge that my ACP benefit discount will transfer to ATC Communications (transfer-in provider). • I acknowledge that my ACP benefit will be applied to ATC Communications (transfer-in provider’s) service and will no longer be applied to service retained from the transfer-out provider. • I acknowledge I may be subject to the transfer-out provider’s undiscounted rates as a result of the transfer if I elect to maintain service from the transfer-out provider. • I acknowledge that I am limited to one ACP benefit transfer transaction per service month, with limited exceptions for situations where I seek to reverse the unwanted transfer or am unable to receive service from a specific provider. * I have read and agree to the terms and conditions listed above Name * Name First First Last Last Signature of ACP Subscriber Clear Date signed by ACP Subscriber reCAPTCHA If you are human, leave this field blank. Submit
