The Affordable Connectivity Program Form

To apply for the Affordable Connectivity Program through Alpine Communications, please follow the steps below.

Step 1: Visit the National Verifier to confirm your eligibility for the ACP Benefit. You must complete this step first. Alpine Communications cannot enroll you in this program if you have not completed this step.

Please note this is a third-party government website that may experience delays due to a high volume of traffic. Alpine Communications is not able to assist in this verification process.

Once you receive confirmation that your National Verifier Application has been approved, return to this page to complete your enrollment process.

Step 2: Once you receive your confirmation email from the National Verifier, please complete the form below and read and accept all terms and conditions to sign up for Alpine Communications service and enroll in the ACP through Alpine Communications.

Please note that the information you provided to the National Verifier in Step 1 must match the information you provide in the form below.

Name (Enter name exactly as it was entered on National Verifier site)(Required)

First Middle Last

Date of Birth(Required)

Last 4 Numbers of Your Social Security Number(Required)

Please enter a number from 0000 to 9999.

Physical Address(Required)

Street Address Address Line 2 City State ZIP Code

My mailing address is the same as the physical address.(Required)

Yes

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

National Verifier Application ID (received in step 1 above)(Required)

I have Benefit Qualifying Person information.(Required)

Yes

Enter name exactly as it was entered on National Verifier site. If no middle name, leave blank.(Required)

First Middle Last

Birthdate of Benefit Qualifying Person(Required)

Last 4 Numbers of Benefit Qualifying Person's Social Security Number(Required)

Please enter a number from 0000 to 9999.

By clicking Enroll I understand that:

The Affordable Connectivity Program (ACP) is a government program that reduces the customer's broadband Internet access service bill by up to $30. The ACP is a federal government benefit program operated by the Federal Communications Commission, and my household will be subject to Alpine Communications's undiscounted rates and general terms and conditions if the program ends, if I transfer my benefit to another provider but continue to receive service from the current provider, or upon de-enrollment from the Affordable Connectivity Program.
Depending on the service tier or bundles, subscribers whose total bill exceeds $30 will be responsible for the remaining balance after the ACP discount is applied.
Alpine Communications may disconnect my household's ACP-supported service after 90 consecutive days of non-payment.
I may apply the ACP benefit to any of Alpine Communications's broadband service offerings at the same terms available to households that are not eligible for ACP-supported service.
My household may obtain broadband service supported by the ACP program from any participating provider of my choosing and I may transfer my ACP program benefit to another provider at any time.
My household may file a complaint against Alpine Communications via the Commission's Consumer Complaint Center at (877) 384-2575.
There is a limit of one benefit per household per month.

By clicking Enroll, I give Alpine Communications permission to:

Apply an ACP discount of up to $30 to the services I receive from Alpine Communications.
Resume normal billing practices and charge me the full service rate once the ACP program ends.

By clicking Enroll I understand that:

By clicking Enroll, I give Alpine Communications permission to:

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