Assistance Programs

Select the program(s) you want to participate in:*

Lifeline or Enhanced LifelineMinnesota Telephone Assistance Plan (TAP)

If you are receiving Lifeline, you may be eligible for our Economy Internet plan—up to 50Mb/3Mb of internet for $30 per month. Would you like to sign up for or move to this plan?*

YesNo

The Economy plan is available in select areas. Call 888.992.7844 to learn about your other speed and pricing options.

Complete the following to participate in the programs selected above.
This will help us accurately update your account and apply any credit(s) you may be eligible for.

Are you an existing Arvig customer?*

YesNo

Preferred Start Date for Service*

Date

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Arvig Account Number

This number is on your monthly bill.

Application ID*

You received this number after you completed your application on the Lifeline website.

If necessary, do we have your permission to transfer your Lifeline benefit to Arvig?*

YesNo

Please indicate which program benefit you would like transferred to Arvig. (Select all that apply.)*

LifelineACP

Date*

Date

Full Name*

Enter exactly how you did on the Lifeline website.

Phone Number*

Last 4 Digits of Your Social Security Number*

Parent

Tribal ID

If applicable

Yes, I live on Tribal Lands

Date of Birth*

Date

Email*

Address You Applied With on the Lifeline Website*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you applying for a dependent?*

YesNo

Dependent Full Name*

Dependent's Date of Birth*

Date

If you are applying under a dependent, please enter the last 4 digits of their Social Security Number*

Dependent

Dependent's Tribal ID

If applicable

Agreement for Service

You are only allowed to get one Lifeline benefit per household, not per person. Your household cannot get Lifeline from more than one company. You must give accurate and true information on this form and on all Lifeline-related forms or questionnaires. Lifeline is non-transferable. Please see the complete Lifeline Program Rules.

By signing below I agree to have Arvig internet service installed and provided to my home under the Affordable Connectivity Program. It is my responsibility to cancel service if the program ends. If I don't cancel service, I understand that I am responsible for the monthly bill.

Agreement for Service

You are allowed to get one Lifeline benefit per household, not per person. Your household cannot get Lifeline from more than one company. You must give accurate and true information on this form and on all Lifeline-related forms or questionnaires. Lifeline is non-transferable to another person, even if they qualify. Please see the complete rules at lifelinesupport.org.*

I acknowledge and consent to the Lifeline Agreement for Service.

By signing below I agree to have Arvig internet service installed and provided to my home under the Affordable Connectivity Program. It is my responsibility to cancel service if the program ends. If I don't cancel service, I understand that I am responsible for the monthly bill. Visit acpbenefit.org for more information.*

I acknowledge and consent to the Affordable Connectivity Program Agreement for Service.

Affordable Connectivity Program Disclosures

(1) The Affordable Connectivity Program is a government program that reduces the customer’s broadband internet access service bill; (2) The household may obtain Affordable Connectivity Program-supported broadband service from any participating provider of its choosing; (3) The household may apply the affordable connectivity benefit to any broadband service offering of the participating provider at the same terms available to households that are not eligible for Affordable Connectivity Program-supported service; (4) The provider may disconnect the household’s Affordable Connectivity Program-supported service after 90 consecutive days of non-payment; (5) The household will be subject to the provider’s undiscounted rates and general terms and conditions if the Affordable Connectivity Program ends, if the consumer transfers their benefit to another provider but continues to receive service from the current provider, or upon de-enrollment from the Affordable Connectivity Program; and (6) The household may file a complaint against its provider via the Commission’s Consumer Complaint Center: call 1-888-225-5322 or visit consumercomplaints.fcc.gov/hc/en-us*

By signing below, I acknowledge that I have received and understand the disclosures regarding the Affordable Connectivity Program (ACP). I affirm that I am eligible to receive the ACP benefit and request that Arvig enroll me in the ACP and apply this benefit to my Internet service. I consent to Arvig transmitting my personal information, including my date of birth and the last 4 digits of my Social Security Number, to the ACP Administrator. I understand that if I do not provide my consent for the transmittal of my personal information to the ACP Administrator for enrollment in the program, I will not be able to receive the ACP benefit.

Affordable Connectivity Program Benefit Transfer Disclosures

(1) The subscriber will be transferring its ACP benefit to Arvig; (2) that the effect of the transfer is that the ACP benefit will be applied to the transfer-in provider’s service and will no longer be applied to service retained from the transfer-out provider; (3) that the subscriber may be subject to the transfer-out provider’s undiscounted rates as a result of the transfer if the subscriber elects to maintain service from the transfer-out provider; and that (4) the household is limited to one ACP benefit transfer transaction per service month, with limited exceptions for situations where the subscriber seeks to reverse an unwanted transfer or is unable to receive service from a specific provider*

I acknowledge that I have received the disclosures related to my request to transfer my Affordable Connectivity Program (ACP) benefit. I understand these disclosures and I consent to the transfer of my ACP benefit to Arvig.

Signature*

Application processing may take up to 2 business days.

Tribal ID Number

Yes, I am opting into the FCC Program.