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Submitted URL: https://api.qlinkportal.com/eMail/emails.svc/Click/QLWLJDYGV3PGJRUG3RZLFZYISKEMNVU7RKOKFTT3PIQLW/309?key=QLWMVVG77KYOE3U57DU...
Effective URL: https://qlinkwireless.com/enroll/quick?&auto=1&type=quick&email=bmV0c2VjQHVzYWMub3Jn&zip=30215
Submission: On February 21 via manual from US — Scanned from DE
Effective URL: https://qlinkwireless.com/enroll/quick?&auto=1&type=quick&email=bmV0c2VjQHVzYWMub3Jn&zip=30215
Submission: On February 21 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOM<form class="">
<div class="form-group">
<div class="input-group"><input name="FirstName" autocomplete="given-name" placeholder="First Name" type="text" class="form-control"></div>
</div>
<div class="form-group">
<div class="input-group"><input name="MiddleName" autocomplete="additional-name" placeholder="Middle Name (Optional)" type="text" class="form-control"></div>
</div>
<div class="form-group">
<div class="input-group"><input name="LastName" autocomplete="family-name" placeholder="Last Name" type="text" class="form-control"></div>
</div>
<div class="d-flex justify-content-center" style="margin-top: 30px;"><button type="submit" class="form-submit btn btn-primary">Continue</button></div>
</form>
Text Content
Enrollment ID: 158809233 Info Plan Eligibility Final Step CONGRATULATIONS This FREE Government program is available in FAYETTEVILLE, GA Enter your info below to set up your account WHAT IS YOUR FULL NAME? Continue EspañolContact UsUniversal FormPrivacy PolicyTCPATerms and Conditions © 2021 Q Link Wireless ™ Q Link Wireless™ is a provider of Lifeline, a non-transferable federal benefit program. You must be eligible to enroll. Lifeline support is limited to one per household on wireline, wireless, or broadband service. If your household’s income is at or below 135 percent of the federal poverty guidelines, or if you participate in a qualifying federal assistance program, you may be eligible for a Lifeline Program discount. Proof of eligibility will be required during enrollment. To view terms visit www.qlinkwireless.com/terms. By submitting this application you consent to receive phone calls from Q Link Wireless to all numbers on your account, which may result in charges to you. This includes, but is not limited to, pre-recorded voice messages and/or automatic dialing system. *The Affordable Connectivity Program (ACP) is an FCC benefit program that provides up to a $30 discount on monthly broadband Internet access service and a single up to $100 discount on certain connected devices to eligible households. Eligibility will be determined by the National Verifier. An ACP eligible household is limited to one monthly service discount and a single one-time device discount. The benefits cannot be transferred to other individuals. Discounted devices are subject to availability and a $10.01 co-pay. If the FCC announces the end the ACP, we end our ACP service offers, or if your household is no longer eligible, we will notify you and you will revert to receiving only the standard FREE Lifeline plan if you are eligible or you may choose from our other service plans available at that time by paying the applicable undiscounted rate plus applicable fees and taxes. Eligible consumers may get ACP service from any participating provider. Your ACP benefits may be transferred to another provider at any time. Lifeline subscribers may continue their existing Lifeline services without enrolling in the ACP and may choose to take ACP benefits from a service provider other than their existing Lifeline provider. For more information about the ACP and your eligibility, visit www.qlinkwireless.com. By opting-in, you authorize Q Link Wireless, for the purpose of applying for, determining eligibility, enrolling in and seeking reimbursement of ACP service and device benefits, to collect, use, share and retain your personal information, including but not limited to information required for the purpose of establishing eligibility for and enrolling in the Lifeline/ACP programs, and including, but not limited to, full name, full residential address, date of birth, last four digits of social security number, telephone number, eligibility criteria and status, the date on which the ACP service discount was initiated and if applicable, terminated, ACP connected device distribution date/type/make and model/status, usage status and other compliance requirements, the amount of support being sought for the service and/or device, and information necessary to establish identity and verifiable address, to the Universal Service Administrative Company (USAC) to ensure proper administration of the ACP service and/or connected device benefits. You also agree that any state, local, Tribal government, school, or school district, may share information about your receipt of benefits that would establish eligibility for the ACP, and that such information will be used only to determine ACP eligibility. Failure to provide this FCC mandated consent will result in you being denied the Affordable Connectivity Program service and/or the connected device benefits. ACP service is subject to our complete terms and conditions. Available speeds will be determined by your particular service plan. Available speeds also depend on other factors, including network availability. Offers may vary by state and service may not be available in all areas. Promotional offers may be modified or withdrawn at any time. For more information about this program please visit www.fcc.gov. ^ACP discounted device offer is subject to product availability. Customers will be notified of device shipment and will receive an invoice for a co-payment of $10.01 after delivery. Device delivery may take 6-8 weeks. ACP Terms & Conditions apply. © 2021 Q Link Wireless