Submit a Ticket | Afnet.com

Your Name *

Address *

Suite/Apt/Room #:

(must add if applicable):

City *

LifeLine States *

If your state is not listed, select 'OTHER STATE' and select from below

Other States

United States Of America

Is this a temporary Address? *

Yes

No

(hotel does not count as temporary address) .

Zip Code *

Last 4 digits of SSN *

Date Of Birth *

Your Email *

Must be personal email (not a VA email)

Customer Phone

Qualifying Program *

Veteran Pension & Survivor Benefit Program - (Required Documents: Award letter or pay/benefit statement)

SNAP - (Required Documents: Award letter or pay/benefit statement)

SSI - (Required Documents: Federal Social Security Administration Award letter or pay/benefit statement)

Medicaid - (Required Documents: Award letter)

Low Income Status - (Required Documents: Current Income Statement or Benefit Statement)

Section 8 Housing - (Required Documents: Lease agreement, award letter or benefit statement)

None

Select one or more that apply.

Attachment

Upload All Required Documents per your Qualifying Program here:
If you are a Veteran, a DD214 is also required.

I am requesting:

Mobile Plan Only (BYOD)

Mobile Plan and a device

Notes

Main Reason For Requesting a Phone

Seeking New Job Opportunities

Staying Connected To Family And Friends

Seeking Veteran Benefit Opportunities

Other

Subject *

Submit a Ticket - Request for Subsidized or Free Service