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ACP Application

  1. Personal Info Some info about you.

  2. Eligibility ACP Eligibility

  3. Plans

Great! Let's get started with some simple information

Please click here to review GoMDUSA's Affordable Connectivity Program details. By continuing this application, you acknowledge reading these important disclosures and agree to all applicable terms and conditions.

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Program Enrollment Information

First Name
Last Name
SSN (Last 4 digits)
Date of Birth

Home Address

Street
Apt. #
Zip Code
City
State @foreach ($states as $s) @endforeach
Is this a rural address?
Yes, this is a rural address
Not a rural address
Is this address permanent or temporary?
Permanent Address
Temporary Address

Contact Information

Phone (10 Digits)
Email Address
Best way to reach you about your application
Preferred Language

Create a 4-Digit Security PIN

Create a 4-Digit Security PIN

4 Digit PIN

Terms & Conditions

Please check each to confirm and continue

By selecting this checkbox and providing your signature below, you are granting authorization to Go MD USA and its representatives to use an automated system for delivering telemarketing calls to the phone number you have provided. This will be done using an automatic telephone dialing system and/or an artificial or pre-recorded voice or text message. Additionally, you acknowledge and agree to receive recurring automated promotional and personalized marketing text messages and emails (such as reminders to complete your application) from Go MD USA at the mobile number provided during sign-up. Please note that your consent is not a requirement for making any purchase, and the frequency of messages may vary.

Affordable Connectivity Program (ACP) Consent

By proceeding with your application, you confirm and comprehend that the Affordable Connectivity Program is a Federal Communications Commission (FCC) benefit program designed to lower your monthly Broadband bill. This program will remain in effect until further notice. In the event that the program is concluded, you will receive a 30-day advance notice and will have the option to continue your plan at the regular, undiscounted rate. As a participant, you have the option to transfer your Affordable Connectivity Program (ACP) benefit to another service provider. It's important to note that the Affordable Connectivity Program is limited to one monthly service discount and one device discount per household.

I acknowledge that I am prohibited from receiving multiple benefits from the Affordable Connectivity Program (ACP) through the same or different service providers. I give my consent to participate or transfer to the GoMDUSA Affordable Connectivity Program.

I confirm that I am currently receiving ACP benefits from another provider. Through this application, I request to transfer my benefits to GoMDUSA.

I affirm that, to the best of my knowledge, my household is not currently receiving an ACP service benefit. I hereby request to enroll for an ACP benefit with GoMDUSA.