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

Name of Prison
Street Address
Address (cont.)
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. For Federal prisons, this section can be left blank.

Institution's Collect Call Provider:

Please SelectUnknownConsolidated CommunicationsEmbarqFSH CommunicationsGlobalTel Link (GTL)Inmate Calling SolutionsPayTel CommunicationsPCSSecurusValue 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?

Please SelectYes, I have to submit a copy of my phone billNo, I do not have to submit a copy of my phone billNot 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 SelectYesNoNot 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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