Wireless Activation Request Form

Complete the form below after completing your Wireless Service purchase.


Section A: Customer Information (must match with the information on your order)

First Name:


Last Name:


E-mail:


Order Number:




Section B: Complete the following to activate with a New Mobile Number. Skip to Section D, agree to the Terms, and click the "Submit" button.

Area Code:


Zip Code:




Section C: Complete the following for Port-In Activations. Transferring your mobile number may take up to 3 business days to complete depending upon the previous service provider's system.

Old Service Provider:


Mobile number to transfer:
Check here if the mobile number is under contract.

Account Holder's First Name:


Account Holder's Last Name:


Account Number (No special characters or spaces allowed):


Account Password/PIN:


Account Address:


City:


State:


Zip Code:




Section D: Terms and Conditions

My Wireless Service purchase will be activated using the information that I have provided above. I agree that there are no returns or exchanges on SIM cards or Wireless Refills.


Thank you for your purchase!