Certifications: (must review and click all to proceed)
A complete and signed Lifeline Service Application and Certification ("Certification") is required to enroll you in TruConnect's Lifeline service program in your state. This Certification is only for the purpose of verifying your eligibility for Lifeline service and will not be used for any other purpose. Service requests will not be processed until this Form has been received and verified by the Company.
I understand I have the right to enroll in the Lifeline service using non-electronic methods. I further understand that I have the right to withdraw this consent at any time prior to activation of my service. The Company has advised me that I may request a paper copy of my contract and associated fees by calling 611 from my wireless handset.
Lifeline is a government assistance program and willfully making false statements to obtain a Lifeline benefit can result in fines, imprisonment, de-enrollment or being barred from the program. Lifeline benefits are limited to a single line of service per household. A household is defined, for purposes of the Lifeline program, as any individual or group of individuals who live together at the same address and share income and expenses. A household may not receive multiple Lifeline discounts. You may apply your Lifeline discount to either one landline or one wireless number, but you cannot have the discount on both and you cannot receive Lifeline benefits from multiple providers. Note that not all Lifeline services are currently marketed under the name Lifeline. Lifeline is a non-transferable benefit and you may not transfer your benefit to any other person, including another eligible low-income consumer. Violation of the one-per-household limitation constitutes a violation of the Federal Communications Commission's rules and will result in your de-enrollment from the program, and potentially prosecution by the United States Government.
Authorizations: (must review and click all to proceed)
Please select your preferred language for future notifications from the California LifeLine Administrator
Please select one of the options
Please select your choice for future notifications from the California LifeLine Administrator. You must contact TruConnect Customer Service directly if you would like to receive future communications from the California LifeLine Administrator in Braille.
To maintain the security of your account please provide a four digit Personal Identification Number (PIN) that will be used to validate your identity when viewing your account online, retrieving account information via our Interactive Voice Response (IVR) system, purchasing additional minutes or otherwise contacting the Company.