Affordable Connectivity Program – Application Form

  • MM slash DD slash YYYY
  • Please provide the account number that is on your current bill.
  • Please provide the account number that is on your current bill.
  • Please provide the Affordable Connectivity Program (ACP) ID Number that was given to you when you enrolled.
  • MM slash DD slash YYYY
  • Subscriber Consent

    AFFORDABLE CONNECTIVITY PROGRAM QUALIFICATION FORM. By signing this form, I give my affirmative consent that I want to participate in the Affordable Connectivity Program through Mosaic Technologies and that I understand and certify that:
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • Initial Here
  • This field is for validation purposes and should be left unchanged.

Headquarters

401 S. 1st Street
PO Box 664
Cameron, WI 54822

  • Toll Free: 800-924-3405

  • Local: 715-458-5400

  • Fax: 715-458-2112

  • Diggers Hotline: 800-242-8511

  • Hours
    Monday-Friday: 8AM-4:30PM

Find remote payment drop boxes at the below locations

BARRON

611 E. La Salle Ave
Barron, WI 54812

CHETEK

704 2nd Street
Chetek, WI 54728

RICE LAKE

20 North Wilson Ave
Rice Lake, WI 54868