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.
718 S West St, PO Box 98
Green City, MO 63545