Free Service & Device | On Purpose Living

LIFELINE Application

LIFELINE FREE SERVICE & DEVICE Please complete the form below to begin your application process.

Name (as it appears on benefits card)(Required)

First Middle Last

Date of Birth(Required)

Last 4 digits of Social(Required)

Delivery Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Enter Email Confirm Email

Contact

Phone(Required)

Qualifications(Required)

Select All

Medicaid Insurance

Food Stamps

Medicare SSDI/SSI (2024 Award Letter)

State Temp. Disability or Section 8

Veterans Pension

2024 W2 or 1099 ($56K/less)

2024 1040-Fill Out ()'s, Unemplyed)

Choose all that apply

Applicant has an UNLOCKED phone for FREE Lifeline T-Mobile service plan SIM and does NOT need a device(Required)

Please ship device via USPS Priority Shipping(Required)

Cash App $12 to $BrandonHNathan

Upload images of Qualifying Documents

Drop files here or

Accepted file types: png, jpg, pdf, Max. file size: 512 MB.