ACP Tablet Order

Affordable Connectivity Program- FREE PHONE APPLICATION

ANYONE WHO IS ON EBT OR MEDICAID WILL QUALIFY AUTOMATICALLY
Do you want a phone? (The SIM cards in the phones can be taken out and used in any Tmobile or unlocked phone. You can download the text now app on the phone also.)
Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Last 4 of Social
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number
Additional Comments
File Upload

Cancelof
Should be Empty:

Affordable Connectivity Program- FREE PHONE APPLICATION