Line Separation Request

We are here to support survivors of domestic violence under the Safe Connections Act.

If you are a survivor of domestic abuse or related crimes, you may request to:

Leave a shared wireless account
Or have an alleged abuser removed from your account.

All requests are confidential and will be processed within two business days once all required information is received.

We will not charge any fees or penalties and will only contact you using the preferred method you specify

To process your request, please provide one of the following documents:

A copy of a signed affidavit from from qualified professional such as a licensed medical or mental health care provider, social worker, victim services provider, or court employee,...
A copy of police report, court order, or other official document showing that you are a survivor of abuse.

We will not contact the alleged abuser or account holder until your line separation is completed.

If you are facing financial hardship, you may qualify for a six-month emergency communications benefit under the Lifeline Program.

For more information, visit www.airtalkwireless.com/lifeline-program or www.usac.org/lifeline/safe-connections-act/

Survivor's Information*

First Name

Last Name

Designated Representative's Information(Optional)

* If someone is assisting with or requesting the line separation on behalf of the survivor, please provide the following information:

First Name

Last Name

Representative's Relationship to the Survivor

Preferred contact method*

PhoneTextEmail

AirVoice Wireless may need to contact you or your designated representative with this information to confirm the request or if we are unable to complete the request.

Special instructions or notes for contacting

Abuser's Information*

First Name

Last Name

Request Details*

Please provide the following details to help us efficiently and effectively process your request.

A Survivor may choose to:

I wish to separate the survivor's line

I wish to separate the line of the abuser.

Supporting Documentation*

Under SCA rules, in order for AirVoice Wireless to process with this line separation request, you must provide documentation that verifies the alleged abuser has committed or allegedly committed a covered act against the survivor or an individual in the survivor's care. Acceptable documentation includes either:

Copy of a signed affidavit form:

• Licensed medical or mental health care provider
• Licensed military medical or mental health care provider
• Licensed social worker
• Victim services provider
• Licensed military victim services provider
• Employee of a court acting within the scope of that person's employment

Copy of police, court, or other official documents:

• Police report
• Statements provided by the police (including military or Tribal police)
• Court order from a magistrate or judge
• Charging documents (a formal accusation alleging that someone committed an offense)
• Protective or restraining orders
• Any other official record documenting the covered act

Upload Supporting Documents

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