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.I acknowledge that once the transfer is complete, I will lose my ACP benefit and/or with my former eligible telecommunications carrier (ETC). I also acknowledge that NEMR has explained that I may not have multiple ACP benefits with the same or different providers, and I am limited to one benefit transfer per service. Transfers will be limited to one per service month. 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)Last Four of SSN(Required) Signature
