Free High Speed / Reduce Cost High Speed Internet Qualification Form
Call us at (800) 965-0401 if you have any questions or to apply with an agent from 8:30 AM - 7:30 PM EST.
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Email *
Location Code / Location or Personnel Name *
The 4 digit code from your agent (example 1234) or your agent's name (example John Doe), If no code please enter "0000"
Do you currently have internet? *
Required
If you have internet, what service provider?
Are you or someone in your household receiving any of these? *
Required
Last Name *
First Name *
Middle Name (if applicable)
What is your Date of Birth *
MM
/
DD
/
YYYY
Social Security Number *
*We are a utility company, this is ONLY used to verify your identity. (NO CREDIT CHECK/INQUIRY!!!), if you provide ONLY the last 4, an agent WILL be reaching out to you for the full number to fully process your application for free or reduced cost internet service.
Service Address *
Full address with apartment number if applicable.
Billing address if different from service address
Main Telephone Number (Mobile) *
Used to schedule instillation
Additional Telephone Number if available
Used to schedule instillation
Security Code *
Use your street number (2222 Main Street, your security code will be 2222)
Electronic Signature (type your full name) *
I agree to have Dehydrate Foods 4 America contact me regarding free or reduced cost internet service, the Emergency Broadband Benefit is a federal program by the FCC to aid low income families and families affected by the COVID-19 pandemic. I understand that Dehydrate Foods 4 America cannot guarantee my qualification for this benefit. I also understand that Dehydrate Foods 4 America will not sell or share my data and it will be kept confidential and only be used to qualify me for the service listed above.
A copy of your responses will be emailed to the address you provided.
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