Same day Approval
Please fill out this form to receive your FREE phone and free monthly service!
Please select a device type
PHONE
Name
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First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
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Month
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Day
Year
Date
Last 4 of SSN
*
SHIPPING ADDRESS if different than home address
By Agreeing to the following terms and conditions, you authorize Simple Wireless to verify the information provided to determine whether you qualify for Lifeline and if you do qualify you give authorization to switch your Lifeline provider. Please Note: If you have already received your free device you will automatically be applied for a free Sim Card with service. By clicking you agree to the terms and conditions.
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