LifeLine Plan
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Step One Apply

Fill this out to apply for Lifeline Service


For Low Income Households, use this form

Income-based Form (PDF)


For particpants of federal or state assistance programs, medicaid, or other programs, use this form

Program-based Form (PDF)

Step Two Certify

Fill this out if someone in your household currently receives a Lifeline-supported service.


This form will certify that you only have one Lifeline phone in your household

Multi-household Form (PDF)

Step Three Submit

All applicants need to reside in the following states: Arizona, New Mexico and Utah.
See our Local Coverage Map for more information. To submit your application, please include:

  • A Copy of Proof of Address (e.g. Utility bills) *
  • A Copy of Federal/State Government-Issued ID (e.g. Driver License, Passport) *
  • A Copy of Proof of Participating Subsidy (e.g. State-Issued EBT card, Letter from Social Security Office) *

    Or to demonstrate household income that is at or below 150% in AZ/NM or 135% in UT of Federal Poverty Level Guidelines

  • A Copy of Proof of Income (e.g. Prior year's tax return, Social Security Statement of Benefits, Unemployment Statement of Benefits, paystubs covering three consecutive months within the past year) *

To submit, fax 928-532-2613 or... Find a Store

About Lifeline

Lifeline is a federal government benefit program and only qualified persons may participate. To be eligible for this program you must reside on qualified Tribal lands in Arizona, New Mexico or Utah and meet certain income requirements or be receiving benefits from one or more common government programs. Applicants must present documentation of income or program participation. FREE4Life includes a discount covering the cost of activation, provided under the federal Link Up program. Lifeline service may not be transferred to any other individual, including another eligible low-income consumer. By law, the Lifeline program is only available for one phone line per household, whether landline or wireless. Consumers who willfully make false statements in order to obtain Lifeline benefits can be punished by fine or imprisonment or can be barred from the program. HAC compatible phones available upon request. Applicable taxes apply. Toll (long distance), data services, roaming and SMS (texting) are not included in your local air time. To utilize these services there must be a monetary ("Recharge") balance equal to or greater than the price of the service. "Roaming' is one Cellular One customer outside of the Cellular One home coverage area making or receiving a call to or from anyone within the Domestic U.S. and applicable charges apply. SMS rate is for incoming and outgoing messages. If you experienced any difficulties with your mobile service, please contact a CellularOne representative at (800) 730-2351. For unresolved consumer issues, you may contact the New Mexico Public Regulatory Commission at 800-663-9782 or the Arizona Corporation Commission at 800-222-7000, or the Federal Communications Commission, Consumer & Governmental Affairs Bureau. Other restrictions may apply. See your FREE4Life wireless Agreement and/or for pricing and additional terms and conditions.