Assurance Wireless ApplicationIf you have arrived at our Assurance Wireless application section from a search engine, please visit our Assurance Wireless page and the Free Government Cellphone main page for very important general program information.


In order to qualify for a free cell phone and cell phone service from Assurance Wireless, you must complete the Assurance Wireless application.  The application itself is generally straight forward and can be completed in as little as five minutes.  There are specific Assurance Wireless application forms for each state that the program is currently available in.  Applicants must take care to fill out the appropriate Assurance Wireless application and the application must filled out completely.  If an application field is left blank or incorrectly completed, it will lower your chances of being accepted into the program.

The Assurance Wireless application form is generally broken down into four catagories:

Section A: Personal Information

The application will ask for your name, contact number, and home mailing address.  Unfortunately, Assurance Wireless can not mail the free cell phone to a PO Box.  A home mailing address is required in order to qualify for free cell phone service from Assurance Wireless.

Section B: Program-Based Eligibility

All states where Assurance Wireless currently offers service provide government assistance program-based eligibility criteria.  The particular government assistance programs vary from from state to state.  So please be sure to check with your states program-based eligibility criteria.  A list states that Assurance Wireless is available in can be found here: Assurance Wireless|States.

In this section, you simply check which programs, if any, you currently participate in.  In most states there is no need to provide supporting documentation proving your involvement in a government assistance program, but some states do have documentation requirements.  So please be sure to check with your state’s requirements.  You can do so on this site or by reading the linked Assurance Wireless application forms below.

Section C: Income-Based Eligibility

The third section of the Assurance Wireless application form is the income-based eligibility section.  Not all states include income-based eligibility criteria.  So check your state’s specific requirements.  In this section you need to select the total income for your household.

Most states rely on the Federal Poverty Guidelines for determining income-based eligibility.  In order to qualify under income-based eligibility criteria your household income must be at or below 100%, 135%, or 150% of the Federal Poverty Guidelines.

If you qualify for Assurance Wireless under income-based eligibility, you must submit proof of income.  Most states accept the following forms as proof of household income:

  • Prior year’s State or Federal income tax return
  • Most recent type of of current statement from the income source(s) noted below:
  • Three consecutive months’ worth of your most recent pay stubs
  • Social security benefits statement
  • Retirement/Pension benefits statement
  • Divorce decree or child support document
  • Unemployment/Workers Compensation benefits statement

Only one of the above mentioned types of income verification need be submitted.  Assurance Wireless will keep the forms they send you.  So if the form is important, make a photocopy and send that in with your Assurance Wireless application.

Section D: Signature

This is the easiest part of the application.  Just put your John Hancock in the space provided and date the form and your done.

Once you have completed the Assurance Wireless application you can submit it by mail to the address provided in the application or by FAX to the number provided in the application.  If you have difficulty completing the application or mailing it, please don’t hesitate to contact Assurance Wireless at 1-888-898-4888.

Below are links to Assurance Wireless application forms for each state where the program is currently available.  We will update this list as service is introduced in new states.

Alabama, Arkansas, Connecticut, District of Columbia, Delaware, Florida, Georgia, Iowa, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, North Carolina, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and West Virginia.

Thank you for visiting our Assurance Wireless application section.