Standing Rock Telecom: Broadband Connectivity Program

Standing Rock Telecom: Broadband Connectivity Program

Subsidized customer support for a year of service 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

Standing Rock Telecom, Inc. (SRT) has been awarded grant funding through the Tribal Broadband Connectivity Program (Program)[1] to help reduce the cost of wireless broadband service (Service) to our subscribers. The Program allows SRT to offer a monthly discount of up to $45 (Discount) to all of our existing and new Service subscribers during the Program period, which begins on January 1, 2025 and which is expected to continue through December 31, 2027 (Program Period). For each year that Program funding is made available to SRT during the Program Period, SRT will draw down Program funds to cover an annual total amount of the monthly Discount for each wireless broadband subscriber and SRT will apply such funds as a monthly Discount credit on Service invoices during the Program Period for each month in which a subscriber receives SRT’s Service.

You must be a current subscriber of SRT’s Service during the Program Period to be eligible for the Discount. If you would like to receive the monthly Discount on your Service for any month during the Program Period in which you subscribe to SRT’s Service, please indicate your agreement by signing and dating this Customer Agreement for Broadband Discount (Agreement).

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

I agree to accept the monthly Discount to be applied as a credit on my monthly invoice for Service for each month in which I am eligible for and subscribe to SRT’s Service according to 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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