I understand that all of this information will be kept
confidential and will only be used as required for
assistance, reports, and audits. By sending this form
it authorizes the ATEL Program to contact VERIZON to verify
telephone service.
I hereby
certify that all of the statements made by me on this electronic form
are true and correct to the best of my knowledge and belief. As long
as I am receiving services, I agree to notify the agency if there is
any change of the information furnished on this form.
