ENROLL | Free Phone Guy

1/3 Personal Info

Plan Enrollment

Get Both Lifeline and ACP for FREE and get:*

Unlimited data

FREE Android Smartphone

Add a tablet for $15.00!

Lifeline only plans include unlimited talk, text, and date monthly. Enroll in the Affordable Connectivity Program (ACP) and if approved, receive a tablet with high speed data. Please review the important information disclosures. You can apply your ACP benefit to any available plan.

Program Enrollment Information

First name

Last name

Last 4 digits of you Social Security Number or Tribal ID Number*

Last 4 digits

Birth Date*

Home Address

City

State

Zip code

Is this a Permanent or Temporary Reidence? Required

Permanant

Temporary

Contact Information

Phone Number

Terms & Conditions

By checking this box, I confirm my agreement with the following. If I am found to be recieving an ACP benefit from another provider, I concent to transfer my benifits from that provider to ours and I understand I will lose the benefits from my former provider.

I acknowledge that my application may require you to determine my eligibility for a benefit granted by a government instrumentality required by law to consider an applicant’s financial responsibility or status. As a result, I understand that you may request consumer reports for that purpose from CGM, LLC, located at 101 Vickery Street, Roswell, Georgie 30075, telephone number (888)594-3860. These reports may include information from phone or internet providers regarding my service enrollment history, or the frequency with which I have received wireless devices, which may be used for enrollment verification and waste, fraud and abuse mitigation purposes.

By clicking NEXT immediately below, I hereby certify, under penalty of perjury, that I accept the above Disclosure Concerning Consumer Reports, Consent to Obtain Consumer Report and A Summary of Your Rights Under the Fair Credit Reporting Act.

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