ACP/Lifeline
To receive discounted cellular or broadband service through the Affordable Connectivity Program and/or the Lifeline Program, please fill out this applicatiThe name you use on official documents, like your Social Security Card or State ID. Not a nickname.
Name
First Name
Middle Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Last 4 of Social
Contact Number
Please enter a valid phone number.
Email
example@example.com
By checking this box and your signature below, you are authorizing, Excess Telecom or its representatives to use an automated system to deliver telemarketing calls to the phone number you provide above using an automatic telephone dialing system, and/or an artificial or pre-recorded voice or text message. Consenting to this agreement is not a required condition of purchasing any goods or services.
accept
Signature
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who recieve Government Assistance
Please Select
Self
Someone in the Household
Affordable Connectivity Program (ACP) Consent
By continuing with your application, you affirm and understand that the Affordable Connectivity Program is an FCC benefit program that reduces your monthly Broadband invoice. The program will be in effect for an indefinite amount of time. At the conclusion of the program, you will be given 30 days' notice and may elect to keep your plan at an undiscounted rate. As a participant you may transfer your ACP benefit to another provider. The Affordable Connectivity Program is limited to one monthly service discount and one device discount per household.
Select the Benefits being Recieved
Please Select
SNAP
Medicaid
SSI
Veterans
Public Housing
Upload Picture ID
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature
Submit
Submit
Should be Empty: