Federal Lifeline Program Authorization and Consent

The Federal Lifeline Program is an FCC benefit program that provides eligible low-income households with a monthly service discount and a connected device discount. Each household is limited to one Lifeline benefit per month from one service provider.

By signing this authorization, you are requesting to enroll in the Lifeline benefit program through North American Local. North American Local will provide support for Lifeline services and enable you to use these benefits on their plans.

Conditions:

1. One Benefit Per Household:Lifeline is a federal benefit, and willfully making false statements to obtain the benefit can result in fines, imprisonment, de-enrollment, or being barred from the program.
2. Household Definition:A household is defined, for purposes of the Lifeline program, as any individual or group of individuals who live together at the same address and share income and expenses.
3. One-Per-Household Limitation:Only one Lifeline service is available per household. A household is not permitted to receive Lifeline benefits from multiple providers. Violation of this limitation constitutes a violation of the Commission's rules and will result in the subscriber's de-enrollment from the program.
4. Non-Transferable Benefit: Lifeline is a non-transferable benefit, and the subscriber may not transfer his or her benefit to any other person.

By signing this authorization, you allow North American Local and its contracted partners to:

• Collect, use, share, and retain your personal information for the purpose of applying for,determining eligibility, enrolling in, and seeking reimbursement under the Federal Lifeline service benefit program.
• Provide your personal information to the Universal Service Administrative Company (USAC) to ensure the proper administration of Lifeline program services and/or connected devices.

Your consent to these terms is required to enroll in the Lifeline benefits provided by North American Local. Failure to provide this consent will prevent your enrollment in the Lifeline program

Certification: You hereby certify that

• You understand and consent to the disclosures provided in this document regarding the Lifeline benefit enrollment.
• You authorize North American Local to enroll you in the Lifeline program.
• You understand that this authorization is contingent upon your eligibility for Lifeline benefits.

Signature:

By signing below, you confirm your agreement to the terms and conditions outlined above and authorize your enrollment in the Lifeline program.

Notice to Consumer: By signing this document, you agree to the terms and conditions outlined above. You will be asked to provide proof of eligibility for the Lifeline program. Providing false information to receive Lifeline benefits is punishable by law.

Transfer Benefits Consent

Please read and initial each statement to confirm you have read and understand the disclosures related to the transfer of your Lifeline Program benefit to North American Local.

• I acknowledge that my Lifeline Program benefit will be transferred to North American Local. *
• I understand that my Lifeline Program benefit will be applied to service from North American Local and will no longer be applied to service retained by my previous provider. *
• I understand, as a result of transferring my Lifeline Program benefit to North American Local, I may be subject to my previous provider’s undiscounted rates if I choose to retain service from that provider. *
• I understand that I cannot have multiple Lifeline Program benefits with the same or different service providers. *
• I acknowledge that I have received the disclosures related to my request to transfer my Lifeline Program benefit. I understand these disclosures and I consent to the transfer of my Lifeline benefit to North American Local.

PLEASE SIGN BELOW:

I have read the Broadband Internet agreement carefully, fully understand its contents, and voluntarily agree to its terms.