Lifeline Government assisted phone service requires a signed Lifeline Self Certification form
be submitted before the order can be processed. You can either use the on-line form or, download a printable
form then send it to us after filling it out. (The on-line application is not available in all states)
If you submitted your application for phone service using our on-line order process, you probably already submitted the lifeline certification as part of that process.
If you placed your order over the phone, you will need to submit a Lifeline certification form using one of the following two methods.
Follow the link for your state below to get to the customer portal. If this is your first time using the
customer portal, after clicking your state, follow the link that says "register" and use your new
account number to set up your portal access.
Once in the portal, follow the "Update my Lifeline Information" in the Lifeline section.
If you prefer, you can use the section below to print and send us a Lifeline certification.
Follow your state link below to get a printable form. Print out the form, fill it out and sign it, then return it to us.
Once complete, return the form to us using one of the methods below:
- Mail it to the address on the form.
- Fax it to 1-866-700-4736.
- Scan the completed and signed form into your computer then email it to email@example.com
- Take a photograph of the completed form and Text it to firstname.lastname@example.org. (The photo must be a clear, close up, high resolution photo. To Text it, enter the email address, email@example.com, in the "To" field where the phone number would normally go)
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