Centranet ACP Enrollment

1
Name* This field is required.
First Name
Last Name
2
Centranet Account Number* This field is required.Service must be active with Centranet before applying for the ACP benefit.
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Email* This field is required.
example@example.com
5
ACP Application ID* This field is required.Notice: The Application ID, obtained through the National Verifier expires after 90-days.
Application should begin with a Q or B followed by ten numbers: Q/B#####-#####
6
ACP Application Date* This field is required.Please enter the date you applied for ACP
Date
Month
Day
Year
7
Do you live on Tribal lands?* This field is required.https://www.lifelinesupport.org/wp-content/uploads/documents/get-lifeline/fcc_tribal_lands_map.pdf
YESNO
8
Are you transferring your ACP benefit from another internet provider?
YESNO
9
Are you also applying for Lifeline?Please return to https://centranetfiber.com/assistance-programs and fill out the LIfeline Enrollment form.
YESNO
10
Last Four Digits of Applicant's Social Security Number* This field is required.
11
Applicant's Date of Birth* This field is required.
Date
Month
Day
Year
12

Please review the following ACP Terms

https://www.centranetfiber.com/assistance-programs/acp-consent

You will be asked to agree to these statements on the next page.
13
Agree to ACP Terms* This field is required.
I agree to all ACP Terms
14
Signature* This field is required.
Clear
Should be Empty: