Lifeline Service in Florida - 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".

You may return your application along with copies of the documents that prove your eligibility for the Lifeline Service, in one of the following ways:

Fax: 1-866-902-5756

Mail: SafeLink Wireless, Inc.

PO Box 220009

Milwaukie, OR 97269-0009

You choose to apply via: