FORM – ACP Program – RUC LIghtSpeed

ACP Program Application

INFORMATION SUPPLIED BELOW FOR EACH STEP MUST
BE IDENTICAL ON ALL APPLICATIONS

Step 1: Learn more about the Affordable Connectivity Program

Visit acpbenefit.org

Step 2: Fill out the program eligibility form

It is important that you fill out the following form to determine if your household is eligible.
https://www.checklifeline.org/lifeline/?id=nv_flow&ebbp=true

This form will determine if your household will qualify for the Affordable Connectivity Program (ACP).

If you filled out the form and the form determined your household successfully qualifies for the Affordable Connectivity Program, go to Step 3.

Step 3: Apply with RUC/LightSpeed for the Affordable Connectivity Program

Reedsburg Utility/LightSpeed is participating in the Affordable Connectivity Program.

*Note: Steps 1&2 need to be completed BEFORE Step 3. Information in all steps must be
identical to apply. If any information is incorrect in the previous steps, please start the process over.

To start the process with Reedsburg Utility / LightSpeed and OPT-IN to apply to the Affordable Connectivity Program(ACP), fill out the following form:

INFORMATION SUPPLIED BELOW FOR EACH STEP MUST
BE IDENTICAL ON ALL APPLICATIONS

Affordable Connectivity Program (ACP)

SECTION 1:

Qualified Application ID (Received from USAC National Verifier):

Name *

Address *

City, State and Zip *

Phone *

Date of Birth (MM-DD-YYYY) *

Last 4 digits of your Social Security Number *

Did you qualify in Step 1 using the Benefit Qualify Person option (i.e. school lunch program)

Yes. If yes, please provide required information in regard to the qualifying (BQP) individual in Section 2.

No. If no, continue to Section 3.

SECTION 2: Benefit-Qualifying Person (BQP information)

First Name of BQP

Middle Name of BQP

Last Name of BQP

Date of Birth (MM-DD-YYYY) of BQP

Last 4 digits of BQP Social Security Number

SECTION 3:

To opt into the Affordable Connectivity Program(ACP) plan, please read the following, check the authorizations and click SUBMIT.

The Affordable Connectivity Program(ACP) program operated by the Federal Communications Commission (FCC) that provides discounts on monthly broadband Internet access service and certain connected devices. The ACP monthly service and device discounts are non-transferrable. An eligible household is limited to one monthly service discount. ACP Program benefits may be obtained from any participating provider of your choosing and your monthly service benefit may be transferred to another provider at any time. When the FCC announces the end of the ACP program or we end our promotional ACP service offer, we will notify you and you will remain on or revert to the standard internet LightSpeed plan. Our standard terms and conditions apply. If service is canceled within the active ACP program timeframe, ACP assistance may not be available and standard rates and fees will apply.

I authorize Reedsburg Utility/LightSpeed, for the purpose of applying for, determining eligibility, enrolling in and seeking reimbursement of Affordable Connectivity Program (ACP) service and device benefits, to collect, use, share and retain my personal information, including but not limited to information required for the purpose of establishing eligibility for and enrolling in the Lifeline program, and including, but not limited to, full name, full residential address, date of birth, last four digits of social security number, telephone number, eligibility criteria and status, the date on which the ACP service discount was initiated and if applicable, terminated, ACP connected device distribution date/type/make and model/status, usage status and other compliance requirements, the amount of support being sought for the service and/or device, and information necessary to establish identity and verifiable address, to the Universal Service Administrative Company (USAC) to ensure proper administration of the ACP service and/or connected device benefits. Failure to provide consent will result in me being denied the Affordable Connectivity Program service and/or the connected device benefits.

I agree that any state, local, Tribal government, school or school district, may share information about my receipt of benefits that would establish eligibility for the ACP, and that such information will be used only to determine ACP eligibility.

I give express consent for Reedsburg Utility/LightSpeed to contact me to validate my eligibility for or desire to participate in Reedsburg Utility/LightSpeed ACP offers, and other products and services via email, or telephone. For more information see: https://ruclightspeed.com/support/policies/.

(i) The Affordable Connectivity Program is a government program that reduces the customer’s broadband internet access service bill; (ii) The household may obtain Affordable Connectivity Program-supported broadband service from any participating provider of its choosing; (iii) The household may apply the affordable connectivity benefit to any broadband service offering of the participating provider at the same terms available to households that are not eligible for Affordable Connectivity Program-supported service; (iv) The provider may disconnect the household’s Affordable Connectivity Program-supported service after 90 consecutive days of non-payment; (v) The household will be subject to the provider’s undiscounted rates and general terms and conditions if the Affordable Connectivity Program ends, if the consumer transfers their benefit to another provider by continues to receive service from the current provider, or upon de-enrollment from the Affordable Connectivity Program; and (vi) The household may file a complaint against its provider via the Commission’s Consumer Complaint Center. Consumer Complaint Center: Phone: 1-888-225-432-2275; Video Phone: 1-844-432-2275; https://consumercomplaints.fcc.gov/hc/en-us

By clicking submit, you are confirming that you have read and understand these disclosures and are opting in to receive your ACP discounted broadband service from Reedsburg Utility/LightSpeed.

If you are human, leave this field blank.

The Reedsburg Utility Commission shall provide safe, reliable, competitively priced, hometown utility
services that help make this community a desirable place to live and do business.

With LightSpeed Internet, we’ve removed the bandwidth restrictions so customers can fully utilize all their connected devices and have the best online experience.

ACP Program Application

INFORMATION SUPPLIED BELOW FOR EACH STEP MUST
BE IDENTICAL ON ALL APPLICATIONS

Step 1: Learn more about the Affordable Connectivity Program

Step 2: Fill out the program eligibility form

Step 3: Apply with RUC/LightSpeed for the Affordable Connectivity Program

INFORMATION SUPPLIED BELOW FOR EACH STEP MUST
BE IDENTICAL ON ALL APPLICATIONS

The Reedsburg Utility Commission shall provide safe, reliable, competitively priced, hometown utility
services that help make this community a desirable place to live and do business.

Residential Services

Business Services

Current Projects

Contact

ACP Program Application

INFORMATION SUPPLIED BELOW FOR EACH STEP MUSTBE IDENTICAL ON ALL APPLICATIONS

Step 1: Learn more about the Affordable Connectivity Program

Step 2: Fill out the program eligibility form

Step 3: Apply with RUC/LightSpeed for the Affordable Connectivity Program

INFORMATION SUPPLIED BELOW FOR EACH STEP MUSTBE IDENTICAL ON ALL APPLICATIONS

The Reedsburg Utility Commission shall provide safe, reliable, competitively priced, hometown utilityservices that help make this community a desirable place to live and do business.

Residential Services

Business Services

Current Projects

Contact

INFORMATION SUPPLIED BELOW FOR EACH STEP MUST
BE IDENTICAL ON ALL APPLICATIONS

INFORMATION SUPPLIED BELOW FOR EACH STEP MUST
BE IDENTICAL ON ALL APPLICATIONS

The Reedsburg Utility Commission shall provide safe, reliable, competitively priced, hometown utility
services that help make this community a desirable place to live and do business.