Consent Form (Free Unlimited Internet & Sim Card)


 

 

Date of Birth :

 * Only Last 4 digits of SSN *

* Note: P.o. Box and Business Addresses are not Acceptable Please Provide a Service Address *

  1. I am older than 18 years old.
  2. I am the authorized person to make decisions for Internet services and to change the Internet Service Provider.
  3. I have good Cellular Network at my residence.
  4. I am aware that Cathect Communications, is my Wireless Broadband Service provider.
  5. I agree to continue my ACP services with Cathect Communications.

For my household, I affirm and understand that the ACP is a temporary federal government subsidy that reduces my broadband internet access service bill and at the conclusion of the program, my household will be subject to the provider's undiscounted general rates, terms, and conditions if my household continues to subscribe to the service.

I use my ACP services and prefer to continue with Cathect Communications. I acknowledge that my ACP services are with Cathect Communications. I agree that if I relocate I will provide my new address to my service provider within 30 days.

I agree that all of the information I provide on this form may be collected, used, and shared for the purposes of Retention and/or receiving the ACP benefit. I understand that if this information is not provided to the Program Administrator, I will not be able to get ACP benefits.
If the laws of my state or Tribal government require it, I agree that the state or Tribal government may share information about my benefits for a qualifying program with the ACP Administrator. The information shared by the state or Tribal government will be used only to help find out if I can get an ACP benefit.

I agree that Cathect Communications can contact me at any time to follow up on my subscription and future service offerings. I understand and agree to the terms and conditions of the ACP program. If I am enrolled or Transferred with another provider for any reason, in the mid-month or at any time of the preceding month I authorize Cathect Communications to transfer my services back to Cathect Communications as my ACP service provider. All the answers and agreements that I provided on this form are true and correct to the best of my knowledge. I know that willingly giving false or fraudulent information to get ACP benefits is punishable by law and can result in fines, jail time, de-enrollment, or being barred from the program.

I hereby certify that I have read this thoroughly and agreed to this disclosure.

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Signature Certificate
Document name: Consent Form (Free Unlimited Internet & Sim Card)
lock iconUnique Document ID: 2ee5ef9829c003e6533ed82861dfde2f28fdc755
Timestamp Audit
March 11, 2024 1:58 pm EDTConsent Form (Free Unlimited Internet & Sim Card) Uploaded by karle steel - karle@cathectc.com IP 154.192.0.44