EBB Opt-In Form

Emergency Broadband Benefit Program Customer Opt-In with NEMR Telecom

Failure to complete this form will result in termination of service upon the conclusion of the program, scheduled to begin on May 12, 2021.
I, listed as the name above, will stay on the selected service plan stated once the Emergency Broadband Benefit Program discount ends.
I understand that by choosing to stay on the service plan stated, that I am responsible for the full undiscounted amount per month listed below:

MM slash DD slash YYYY