Please complete this form to determine which communication program you may qualify for. We use the below requested information to perform a check in the lifeline database to validate your eligibility. A representative will contact you with further instructions. Please note, if your address listed below is different from your ID a piece of mail with your correct address will be required. Please also be aware, if approved for a device, all other lifeline programs with the same address provided are subject to cancellation.
Thank you. Your information was received. A representative will contact you within 24 hours!
