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ACP Customer Enrollment Form

ACP Customer Enrollment Form

This enrollment form is for Breezeline customers who have already been approved by the National Verifier to participate in the Affordable Connectivity Program (ACP).

Not yet a Breezeline customer?

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Not yet approved for ACP?

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Before you get started, make sure you have your Breezeline account information, which can be found on your Breezeline bill or in MyAccount and your Affordable Connectivity Program approval from the National Verifier. After you’ve submitted your ACP enrollment form, we will review and process it within 1 business day. If you qualify, we will enroll you in the Breezeline Affordable Connectivity Program. ACP credits for new enrollees will be applied to the next bill after the date of enrollment; thereafter, ACP credits will be applied by the 10th of each month.

Visit our ACP page for more details about the program.

TIPS! Complete this enrollment form with the same information you used to get approved by the National Verifier for the ACP program. You must complete all required fields (marked with an *).

Additional ACP Resources