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Emergency Broadband Benefit Program (EBBS) Customer Option Form Date: Customer Name (Last, First, MI): Customer Street Address: City: State: Zip: Telephone Number: Mobile: Number: Preferred Email
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Open the sample-ebbp customer opt-in form PDF on your device.
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Start by entering the date in the specified field.
03
Fill in your full name, including first name, middle initial, and last name.
04
Provide your complete address, including street address, city, state, and ZIP code.
05
Enter your email address and phone number in the respective fields.
06
Indicate your preferred method of contact by selecting the appropriate checkbox.
07
If you would like to receive promotional offers, tick the corresponding checkbox.
08
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Sign the form using your handwritten signature.
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Submit the completed form as per the instructions provided.

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The sample-ebbp customer opt-in form is needed by individuals or businesses who want to acquire the consent of customers to receive promotional offers, communicate through preferred contact methods, and gather necessary personal information.
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The sample-ebbp customer opt-in form is a PDF document that customers can use to provide their consent or agreement to participate in a specific program or service.
Any customer who wishes to opt-in to a particular program or service that requires their consent.
Customers can fill out the form by entering their personal information, reading and understanding the terms and conditions, and signing the form to indicate their agreement.
The purpose of the form is to ensure that customers are fully informed about the program or service they are opting into and to obtain their consent in a documented manner.
The form may require information such as the customer's name, contact details, account number, the specific program or service they are opting into, and any relevant terms and conditions.
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