If you have reached this page first by web search, see our Free Government Cell Phones  page for more information.

Assurance Wireless Application Form Details


Filling out the Assurance Wireless application for a free cell phone is short and very easy to complete. Nevertheless, it is important that the application be filled out carefully and completely, as some applicants have been denied only because they did not complete all of the information.

The application form is slightly different from state to state, as the requirements for each are different, but there are parts they all share.  We will review each of those parts:

Personal Information

Basic information like name, address and phone number is required for this section. Please note:

  • A street address is required. No application that uses a PO  Box will be approved
  • Any Assurance Wireless phone is non-transferable and must always remain the property of the applicant listed under this section. The phone cannot be resold or given away.
  • Only ONE Lifeline phone is allowed per household. If any member of your household already has a phone from Assurance or another carrier, you should not apply for an Assurance Wireless phone. Violators can be subject to fines.

Program Based Eligibility

If you participate in a qualifying governmental assistance plan, select the appropriate plan in this section. Some states require that documentation be sent in with the application. If mailing the application, be sure to send photocopies as the materials will not be returned. If you qualify under this section, there is no need to complete the Income-Based Eligibility section.

Some states do not require any documentation for this section.  In the past, many people have falsely completed this section. However, in 2012 the government began serious efforts to uncover people who are participating in the program but do not qualify under the guidelines. Everyone should know that falsely filling out an application for a free phone is considered a crime punishable by either fines or even possible imprisonment.

Income Based Eligibility (not offered in all states) – You may qualify under this section if your income is below the guidelines set in your state, (please see the chart on the home page for information). You will be asked to provide documentation to verify your income. The required documentation is listed on the form and if mailed in, copies will not be returned to the applicant.

Signature- By signing, you are affirming under penalty of law that you have filled out the application truthfully; that all of your submitted documentation is valid; that you will maintain only one Lifeline Assistance Program phone (even across providers) and that if you are no longer eligible under the program, that you will notify Assurance Wireless within 5 days.

I’m ready! Give me a copy of the Assurance Wireless Application!

Click below on the state you reside in.  On the following page you will see that states’ requirements and a link to your state’s application form.

Alabama, Arkansas, Colorado, Connecticut, District of Columbia, Delaware, Florida, Georgia, Idaho, Iowa, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, MassachusettsMichigan, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North CarolinaOhio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, West Virginia and now Wisconsin (clicking on the state will take you to that state’s page)

Assurance Wireless is pending in California. You can see what the qualifications might look like by going to our Assurance Wireless California page.

When you have completed the form you may either mail it, along with any required documentation to the address listed on the application. For faster receipt, you may also FAX the application to 1-877-732-3018.

If you have any further questions about the application itself, contact Assurance Wireless ‘ customer service number 24 hours a day at 1-888-898-4888.

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