Greetings!

~Thank you for visiting our

Lifeline/ACP Self-Enrollment Site.

~We'll help you get your new Smartphone ASAP!

1. First and Last Name

Qualifying Benefits

2. Select All Benefits You Have: *

Identity Information

Birth Date

3. Last 4 of Social Security Number

Contact Information

4. Phone # To Reach You

5. What's your Email(Optional)

Current Address

6. Current Address, City, State, Zip

7. How Many People In Your Household

~Snap a pic of your ID/Award Letter and submit it on this form below.

~Be sure to get all 4 sides and all 4 corners or we won't be able to use it.

~We will get you pre-qualified in 24 hrs.

~If we get you qualified sooner we may call you later today. So make sure you leave us a good contact number.

Do You Have An ID or Driver's License!

8. Driver License/ State ID (Un-expired)

Photo ID

~If you don't have an ID then you can use either Medicaid Card OR your Birth Certificate.

9. Birth Certificate

Birth Certificate

10. Social Security Card

Social Security Card

~If you use a Birth Certificate or a Medicaid card then you must upload a piece of mail with your address on it.

11. Ex: Award Letter, Foodstamps, Medicaid, SSI, Disability, Social Security(Retirement), Utility Bill

Award Letter

Who Referred You To Us?

Who Referred You To This Link *