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CA Lifeline & The Affordable Connectivity Program Enrollment Form


To apply for the California Lifeline & Affordable Connectivity Program, each section of this form must be completed. By continuing your application, you affirm and understand that the Affordable Connectivity Program is an FCC benefit program that reduces your monthly Broadband invoice. The program will be in effect for a period of one year or twelve months from the time of enrollment. At the conclusion of the program, you will be given a 30 day notice and may elect to keep your benefit for an additional year at a discounted rate or free depending on your plan. As a participant you may transfer your benefit to another provider. The Affordable Connectivity Program benefit is limited to one monthly service discount and one device discount per household. Although the Affordability Connectivity Program has ended in February 7, 2024 for new customers, Abreeze Wireless and/or it's affiliates may offer an alternative smart device or program benefits depending on availability. You may also be eligible through the California Lifeline Program, depending on your place of residency and program guidelines. We may elect to notify you via email of the program requirements or any updates on the ACP Program renews or your benefits transfer eligibility. Thank You!
First Name 2nd Last Name Middle Name Last Name Suffix? E-mail DOB Who receives government assistance? (SNAP, Medi-cal etc) Please email us and attach your (proof of benefits & proof of address) to: affordableconnectionsrep@gmail.com Last 4 Digits (SSN) Please choose your qualifying benefit:
Do You Currently Receive CA Lifeline or ACP Benefits With A Free Device? This Includes A Tablet or Free Broadband?
Yes
No
Choose A Device (Availability & Alternatives May Vary) Zip Code Valid USA Mailing Address (Include City, State & Unit#) What is the best way to reach you? Message Submit