Cellphone Service Application

Cellphone Service Application
Plan Enrollment

Combine Lifeline and ACP Benefits to get the most out of your Plan! Enroll in both Lifeline and ACP and if approved receive an additional unlimited monthly high-speed data. Please review the important disclosures. You can apply your ACP benefits to any available plan.
Yes, enroll using both Lifeline and ACP for free (includes Unlimited data, Free Android Smartphone, Option to add tablet for $30.00) Recommended

YES
NO thanks, enroll me in Lifeline only (4.5GB of data)

NO
Program enrollment information

First NameLast Name
Lat 4 Digits of your SSN
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this a permanent or temporary address?

PermanentTemporary
Ship to a Different Address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Preferred Language
Opt-in for SMS notifications Stay connected by opting in for SMS notifications. Receive important account updates and exclusive offers on your future phone number.

Yes, text me important account updates and program renewal notices.Yes, text me exclusive offers, promotions, and special discounts.
By opting in to SMS notifications, you agree to receive texts to your future phone number. Message and daa rates may apply. Message frequency varies. Reply HELP for help. Rely STOP to opt out.
Create a 4-Digit Security PIN To better serve you and protect your identity, select a 4-digit PIN (personal identification number) You will need this when contacting support
Date

MonthDayYear
Date

My Products

Android C7Lifeline and ACP Unlimited Talk. Text & Data (free) Phone Sim, and 2 Months of Prime TV.

$ Free

Alcatel Joy Tablet + Android C7 Product Image

Alcatel Joy Tablet + Android C7 Lifeline and ACP Unlimited Talk. Text & Data (free) Phone Sim Card, and 2 months of Prime TV

$30.00 Quantity

Product Name

$ Free Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature

Clear
Should be Empty:

Cellphone Service Application

Plan Enrollment