SWTexas ACP Part II
For Official Use - SW Texas will complete the questions below. (DO NOT FILL THESE QUESTIONS OUT.)
SW Texas will complete the below questions when they receive the application.
ACP Applicants Name:
Customer eligibility confirmed in National Verifier?
Customer information queried in National Lifeline Accountability Database?
NOTE: this record and any related documentation of eligibility must be maintained for a minimum of 6 years after the last date the above-named customer received ACP program benefits.
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: SWTexas ACP Part II
Agree & Sign