Service Electric Cable TV

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Click here if you live in or near Hazleton, Mahanoy City, Birdsboro or Sparta

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Please fill out the following EBB Form.
PLEASE NOTE: you must use the exact information used on your National Verifier Application. We strongly advise logging into the National Verifier portal and clicking on the 'Qualified' status next to your EBB Program application on your account home page.



First Name:


Middle Name/Initial:


Last Name:


Street Address:


City, State Zip:


Phone Number:


Email Address:


Last 4 Digits of SSN:


Date of Birth:
  

SECTV Account Number (for exisiting customers):


NLAD Customer Eligibility Number:


Eligibility Code:














Benefit Qualifying Person's School Name (only required for Eligibility Code E50):


Benefit Qualifying Person's First Name (only required if different than applicant):


Benefit Qualifying Person's Middle Name/Initial (only required if different than applicant):


Benefit Qualifying Person's Last Name (only required if different than applicant):


Benefit Qualifying Person's Date of Birth (only required if different than applicant):
  

Benefit Qualifying Person's Last 4 Digits of SSN (only required if different than applicant):


I am aware that this is a temporary program and that I am responsible for all charges above the $50.00 credit allowed. I agree to the terms of this service.


I am aware that the program may end mid month and I will receive a partial credit the last month.


I am opting to continue Internet service after the program ends. If yes, I agree that I will be responsible for service billing at the standard monthly rates.


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