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110 / EMAIL: lwforms lifewireless.com A complete and signed Lifeline Service Application and Certification ( Certification ) is required to enroll you in Telrite Corporation / Life Wireless Lifeline service program in your state. This Certification is only for the purpose of verifying your eligibility for Lifeline service and will not be used for any other purpose. Service requests will not be processed until this Form has been received and verified by Company. One Lifeline service per h.
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