Free Lifeline Phone Service

*Eligibility & Household Confirmation: By checking this box I confirm that: 1.) I am over 18 and I currently participate in a qualifying federal assistance program or meet Lifeline income eligibility requirements 2.) Only one Lifeline service is currently active in my household 3.) All information submitted on this form is truthful and accurate — I understand that false information may constitute fraud under federal law

*Appointment & Device Acknowledgment: By checking this box I confirm that: 1.) I understand that a one-time device activation fee applies ($20–$100 depending on device selected) and is due at or before my appointment 2.) I will bring a valid unexpired government-issued photo ID that matches the name on my benefits card exactly 3.) Device availability is subject to current inventory.

*Communication & Referral Consent: By checking this box I confirm that: 1.) I consent to being contacted by ProLogic Strategies via the email provided with appointment instructions and follow-up communications 2.) I agree to receive a referral link to prologicstrategies.com upon submission 3.) I may opt out of future communications at any time