Standing Rock Telecom: Broadband Reconnection Program

Standing Rock Telecom: Broadband Reconnection Program

Subsidized customer credit on SR Telecom Account.
Standing Rock Telecom Customer Name on Account

First NameLast Name
SR Telecom Phone Number (MUST BE SR TELECOM NUMBER)*
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
SSN LAST 4 DIGITS*
Social Security Number
TRIBAL ENROLLMENT NUMBER*
Has to be an enrolled member of US Federally Recognized Tribal Nation (123A - 123456)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Customer Agreement for Broadband Reconnection Discount

Standing Rock Telecom, Inc. (SRT) has been awarded grant funding through the Tribal Broadband Connectivity Program (Program)[1] to help reduce the cost of reconnecting our subscribers to wireless broadband service (Service). The Program allows SRT to offer a one-time discount of up to $300 (Reconnection Discount) to a limited number of SRT customers who previously subscribed to but have been disconnected from their Service. Reconnection Discounts are only available until all Program funds awarded for such discounts have been utilized. Any subscriber eligible for a Reconnection Discount will receive a credit towards the cost of Service reconnection on the first monthly invoice after having reconnected to SRT’s Service.

You must have previously subscribed to and been disconnected from SRT’s Service to be eligible for the Reconnection Discount. If you would like to receive the one-time Reconnection Discount for reconnecting your SRT Service, please indicate your agreement by signing and dating this Customer Agreement for Broadband Reconnection Discount (Agreement).

Please contact us at 701-854-7098 if you have any questions about the Program, the Reconnection Discount, or the terms of this Agreement.

[1] SRT applied for and was awarded funding from the National Telecommunications and Information Administration for funding offered through the Tribal Broadband Connectivity Program to promote affordable wireless broadband to all tribal communities within the Standing Rock Sioux Tribal Nation.
I agree to accept the one-time Reconnection Discount to be applied as a credit on the first monthly invoice after I have reconnected to SRT’s Service according to the terms of this Agreement.*

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Date of signature*

MonthDayYear
Date
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