Name (Enter name exactly as it was entered on National Verifier site)
*
First
Middle
Last
Date of Birth
*
Last 4 Numbers of Your Social Security Number
*
Physical Address
*
Street Address
Address Line 2
City
Armed Forces AA
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Alabama
Armed Forces AP
Arkansas
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South Carolina
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Tennessee
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Utah
Virginia
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Vermont
Washington
Wisconsin
West Virginia
Wyoming
State
ZIP Code
HTC Account Number
*
Mailing Address
My mailing address is the same as the physical address.
Street Address
Address Line 2
City
Armed Forces AA
Armed Forces AE
Alaska
Alabama
Armed Forces AP
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Federated States of Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Mexico
New Jersey
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Palau
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
State
ZIP Code
Email
*
Phone
*
By clicking Enroll I understand that:
The Affordable Connectivity Program (ACP) is a temporary government program that reduces the customer's broadband Internet access service bill by up to $30. The ACP is a federal government benefit program operated by the Federal Communications Commission, and my household will be subject to HTC's undiscounted rates and general terms and conditions if the program ends, if I transfer my benefit to another provider but continue to receive service from the current provider, or upon de-enrollment from the Affordable Connectivity Program.
Depending on the service tier or bundles, subscribers whose total bill exceeds $30 will be responsible for the remaining balance after the ACP discount is applied.
HTC may disconnect my household's ACP-supported service after 90 consecutive days of non-payment.
My existing Lifeline discount, if it is currently being applied to internet service, will be applied to my bill first, then the ACP credit will be applied.
I may apply the ACP benefit to any of HTC's broadband service offerings at the same terms available to households that are not eligible for ACP-supported service.
My household may obtain broadband service supported by the ACP program from any participating provider of my choosing and I may transfer my ACP program benefit to another provider at any time.
My household may file a complaint against HTC via the Commission's Consumer Complaint Center at (877) 384-2575.
There is a limit of one benefit per household per month.
By clicking Enroll, I give HTC permission to:
Apply an ACP discount of up to $30 to the services I receive from HTC.
Resume normal billing practices and charge me the full service rate once the ACP program ends.
Transmit the personally identifiable information that I provided in my application, including my name, phone number, date of birth, physical and mailing addresses, email address, last four digits of my social security number (SSN), and if applicable, the name, date of birth and last four digits of the SSN for my benefit qualifying person (BQP), to the program Administrator. This information is being transmitted to ensure the proper administration of the Affordable Connectivity Program (ACP), and failure to provide this consent will result in me being denied the ACP benefit.
Consent
*
I agree to the above listed terms and conditions.
Enter Code
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Enroll