16. I understand that the $30.00 subsidy for my broadband service will be paid by the government to IJ Wireless, INC
17. I am aware that there is a one-time payment of $10.99 for the tablet device.
18. I understand that it may take 5 to 15 days to get internet services depending on the earliest possible window.
19. By agreeing to this authorization, I allow IJ Wireless, INC to access any records necessary to verify my eligibility for the Affordable Connectivity Program. I understand that this authorization is solely for the purpose of verifying my participation in the program and will not be used for any other purpose.
20. I acknowledge that the Affordable Connectivity Program is a temporary federal government subsidy that reduces my broadband internet access service bill. At the conclusion of the program, my household will be subject to IJ Wireless, INC's undiscounted general rates, terms, and conditions if my household continues to subscribe to the service.
21. To qualify for the program, my annual household income must be 200% or less than the Federal Poverty Guidelines. I agree to provide my new address to IJ Wireless, INC within 30 days if I move. I understand that I need to inform IJ Wireless, INC within 30 days if I no longer qualify for the ACP benefits or if another member of my household who qualified for the program no longer qualifies.
22. I confirm that no one else in my household is receiving Affordable Connectivity Program benefits, and my household is only eligible for one ACP benefit. Even if I switch providers, I understand that I can only receive one connected device (tablet) through the ACP benefit.
23. I agree that all the information I provide on this form may be collected, used, shared, and retained for the purposes of applying for and/or receiving the ACP benefit.
24. If required by the laws of my state or Tribal government, I authorize them to share information about my benefits for a qualifying program with the ACP Administrator. The information shared will only be used to determine my eligibility for the ACP benefit.
25. I also agree that IJ Wireless, INC may contact me at any time to follow up on my subscription and future service offerings. If I enroll or transfer with another provider for any reason, I authorize IJ Wireless, INC to transfer my services back to them as my ACP service provider.
26. I declare that all the answers and agreements provided on this form are true and correct to the best of my knowledge.
27. I understand that willingly providing false or fraudulent information to obtain ACP benefits is punishable by law and can result in fines, jail time, de-enrollment, or being barred from the program.
The certification below applies to all consumers and is required to process your application.
28. I was truthful about whether or not I am a resident of Tribal lands, as defined in the "Your Information" section of this form.
Signature Date [esigtemptodaydate name="esig-sif-today-1670457770820" sadverify="III1ud640" displaytype="border"I am over 18 years old and authorized to make decisions regarding internet services and change my internet service provider.
