ACP Benefit Transfer

ACP Benefit Transfer

I 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
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