Blank Application Request
Download and fill out the application. Then, read the Terms and Conditions on the second page of the application. If you agree with the Terms and Conditions, sign and date the application at the bottom of the second page on the lines labeled "Printed Name", "Applicant Signature" and "Date".
If you elect to qualify based on your level of income, you will have to return your signed application back to Safelink Wireless®. The Florida Office of Public Counsel (OPC) will send you a letter requesting proof of your household income level to determine your eligibility for the Lifeline service.
If you elect to qualify based on your level of income, you will have to return your signed application along with copies of the documents that prove your eligibility for the Lifeline service.
You may return your application to us in one of the following ways:
SafeLink Wireless, Inc.
PO Box 220009
Milwaukie, OR 97269-0009
3. UPS Fax and copy services:
*Important: Only for UPS Fax and Copy Services use the following fax number: 1-888-769-3890
- Find your closest UPS Store by clicking the icon on the map:
- Visit The UPS Store for fax and copy services. You will also need to take current proof documents that prove your eligibility for Lifeline Service.
- Once you are in the store let the UPS Representative know that you are a SafeLink customer and are in the store for fax and copy services.
- Make copies of your proof. Please note: You MUST write your full name in every page that is faxed.
- When you are ready fax your documents to the following number: 1-888-769-3890