ACP Benefit Transfer ACP Benefit TransferI hereby authorize the transfer of my ACP benefit to Northeast Missouri Rural Telephone Company (NEMR). I give permission for NEMR to initiate the transaction in NLAD on my behalf to transfer said benefit to NEMR.1) I consent to transfer my ACP benefit to NEMR.2) I understand that by transferring my ACP benefit to NEMR, I will no longer be able to apply the ACP benefit to the service provider that my ACP benefit currently applies to.3) I understand that I will be subject to the undiscounted rates for my current ACP supported service provider.4) I understand that I am limited to one ACP-transfer per service month with limited exceptions.5) I understand all of the disclosures listed on this document.My signature below is proof of consent to the above transaction rules. NEMR 718 S West St, PO Box 98 Green City, MO 63545 660-874-4111 Name(Required) First Last Date MM slash DD slash YYYY Contact Phone(Required)D.O.B.(Required) MM slash DD slash YYYY Last Four of SSN(Required) Delinquent households that have not paid their monthly service fee for more than 30 consecutive days, will have their service downgraded to the lowest available service tier. They will remain at that service tier until their payments are current and they request to be returned to their original tier. If there is an existing deposit on their account, the deposit amount will be applied to their outstanding balance once their service has been disconnected. Should that customer wish to reconnect their account, per company policy they will be charged the standard installation fee and may be charged a deposit not exceeding the estimated charges for two (2) months service. Signature
