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Lifeline is an FCC program that helps make communications services more affordable for low-income consumers. Lifeline provides subscribers a discount on qualifying monthly telephone service, broadband Internet service, or bundled voice-broadband packages purchased from participating wireline or wireless providers. The discount helps ensure that low-income consumers can afford 21st century connectivity services and the access they provide to jobs, healthcare, and educational resources.

Lifeline Application Form

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Please provide account number that is on your current bill.
Please provide the FCC Lifeline ID Number that was given to you when you enrolled.
How Did You Qualify?(Required)
Benefit Qualifying Person (BQP) Name(Required)
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Please Fill in your year of birth
Customer Name(Required)
Billing Address(Required)
Valid Email Address(Required)

Subscriber Consent


By signing this form, I give my affirmative consent that I want to participate in the Affordable Connectivity Program through Gearheart Fiber, Inter Mountain Cable, Coalfields Telephone or Mikrotec CATV and that I understand and certify that:

Signature Needed