First Name

Middle Name

Last Name

Current Lifeline Cell Phone Number
Do not include a "1" (419-555-5555)

Date Of Birth JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
*Must be 17 years of age or older.
Your EBB plan is separate from your Lifeline plan.
Please click here and we will load this plan monthly on top of your existing Lifeline plan, for FREE, using your current phone number for your convenience right after you opt-in below.
Please click here to also affirm that I want to continue to receive my EBB benefit for the next 30 days.
I authorize Your Call Wireless and its contracted partners, for the purpose of applying for, determining eligibility, enrolling in and seeking reimbursement of Emergency Broadband Benefit Program (EBBP) service and device benefits, to collect, use, share and retain my personal information, including but not limited to information required for the purpose of establishing eligibility for and enrolling in the Lifeline program, and including, but not limited to, full name, full residential address, date of birth, last four digits of social security number, telephone number, eligibility criteria and status, the date on which the EBBP service discount was initiated and if applicable, terminated, EBBP connected device distribution date/type/make and model/status, usage status and other compliance requirements, the amount of support being sought for the service and/or device, and information necessary to establish identity and verifiable address, to the Universal Service Administrative Company (USAC) to ensure proper administration of the EBBP service and/or connected device benefits. Failure to provide consent will result in me being denied the Emergency Broadband Benefit service and/or the connected device benefits.
I agree that any state, local, Tribal government, school or school district, may share information about my receipt of benefits that would establish eligibility for the EBBP, and that such information will be used only to determine EBB eligibility.
I give express consent for Your Call Wireless and its contracted partners to contact me to validate my eligibility for or desire to participate in Your Call Wireless EBB offers, and other products and services via email, telephone, or text messaging. Text messaging and data rates may apply. Consent for calls and texts is optional and can be revoked at any time. For more information see our Terms and Conditions and Privacy Policy at www.yourcallwireless.com
By clicking on the SUBMIT button, you acknowledge and confirm that you have read and understand the disclosures below and to OPT-IN to your EBB discounted broadband service.
submit