Secure Lifeline Application

Apply for Lifeline Phone Service

Complete the application below and our team will review your eligibility details. Your submission receives a reference number for follow-up.

Secure submission

Server-side validation

Human review

Application team review

Device request

Subject to availability

Before you apply

Have a valid email and U.S. phone number available.
Know which Lifeline qualifying program applies to your household.
Device model and service availability can vary by state, carrier and inventory.

Do not submit your Social Security number, benefit card number, passwords or identity documents through this form. If verification documents are needed, our team will provide the appropriate secure next step.

Application Form

Applicant information

Fields marked with * are required.

1. Contact details

First name *Last name *Email address *Phone number *

2. Service address

Street address *

City *State *ZIP code *

3. Eligibility and service preferences

How does your household qualify? *Do you currently receive Lifeline service? *Preferred device *Preferred language *Preferred contact method *

4. Security check and consent

Human security check: 4 + 3 = ? *

This math check is verified by the server before the application can be accepted.

I confirm that the contact and application information I entered is accurate and I authorize Wireless Free iPhone to contact me regarding this Lifeline application.I understand that Lifeline eligibility must be verified and that device model, network, plan and inventory availability can vary. Submitting this form does not guarantee approval or a specific iPhone model.

Your application is sent to our application team at support@wirelessfreeiphone.com. We do not sell application submissions.