By signing this form, I acknowledge and give my affirmative consent that I want to participate in the Lifeline Program through ALLBAND and that I understand and certify that:

1. The Lifeline Program is a government program that reduces the customer's voice and/or broadband internet access service bill.
2. I may obtain Lifeline-supported voice and/or broadband service from any participating provider of my choosing.
3. I may apply the Lifeline benefit to any voice and/or broadband service offering of the participating provider at the same terms available to households that are not eligible for Lifeline-supported service.
4. Allband may disconnect my Lifeline-supported service after 90 consecutive days of non-payment.
5. I will be subject to Allband’s undiscounted rates and general terms and conditions if the program ends, if I transfer my benefit to another service provider but continue to receive service from Allband, or upon de-enrollment from the Lifeline Program.
6. I may file a complaint against any service provider via the Commission's Consumer Complaint Center.
7. Lifeline provides a discount of up to a $9.25 per month toward broadband or bundled service (broadband and voice) for eligible households, and $5.25 for voice only. I will be responsible for the remaining balance after the Lifeline discount is applied. This includes any taxes and required fees that are applied to the full amount of the service.
8. I may only receive one Lifeline benefit per household, from one participating provider, and I certify that no other member of my household is receiving a benefit under the Lifeline.
9. Official communications for Lifeline may also be via email and I consent to receive such communications from Allband.
10. I agree that all information I provide on this form and any service enrollment form may be collected, used, shared, and retained for the purposes of applying for and/or receiving the Lifeline benefit.
11. I understand that I have to tell my service provider within 30 days if I no longer qualify for Lifeline.
12. My service provider may have to check whether I still qualify at any time. If I need to recertify (renew) my Lifeline benefit, I understand that I have to respond by the deadline or I will be removed from Lifeline and my Lifeline benefit will stop.
13. All the answers and agreements that I provided on this form are true and correct to the best of my knowledge.

By signing this form, I acknowledge and give my affirmative consent to transfer my ACP benefit to Allband, and agree and certify:

1. That the effect of the transfer is that the ACP benefit will be applied to my services through Allband and will no longer be applied to service retained from the transfer-out provider;
2. That I may be subject to the transfer-out provider's undiscounted rates as a result of the transfer if I elects to
   maintain service from the transfer-out provider, and
3. That my household is limited to one ACP-transfer transaction per service month with limited exceptions to reverse an improper transfer or address situations impacting the household's receipt of ACP-supported service
   from a particular provider.