Please fill out this form and an Agent will ship you a phone if you are eligible. Also, an Agent may give you a call if more information is needed or your phone request was rejected by the National system and more income or identification documents are needed. By filling out this form, you agree to have an EBB phone ordered and shipped to you. The Agent handling your personal information has been trained to not share personal information of EBB phone requestors outside the scope of providing this service. It is our policy that personal information is prohibited from being shared or used outside the scope of this service.