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First Name
Last Name
Phone
Street Address
Address (cont.)
City
State
Zip/Postal Code
E-mail

Prison/Jail
Street Address
City
State
Zip/Postal Code
Main Phone Number

Choose the type of institution: Federal, State, County/City

Federal Prison	State Prison
County/City	Don't know

Please provide as much information as you can. The more we know, the better we can help you.

Institution's Collect Call Provider:

Please Select Unknown Consolidated Communications Embarq FSH Communications GlobalTel Link (GTL) Inmate Calling Solutions PayTel Communications PCS Securus Value Added Communications (VAC) Other    

If other enter name: 

To set up a prepaid account with the prison's phone provider, do you need to submit a copy of your phone bill? This is very important and will determine which plan we can provide for you.

Please Select Yes, I have to submit a copy of my phone bill No, I do not have to submit a copy of my phone bill Not sure

Some prisons allow the inmates to purchase phone calling credits or have what is called a phone debit account so that the inmate can pay for the cost of the calls. If you know, can the inmate purchase phone calling credits from commissary or can the inmate have a phone debit account?

Please Select Yes No Not sure

Please explain in the box below what problems, if any, you or others have encountered in setting up a prepaid account in the past with the provider using a phone number that does not match your zip code. Give as much detail as you can. We can usually find a work-around for provider-specific problems.

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