California Lifeline Renewal Form Sample
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4California LifeLine Program
RENEWAL FORM
To continue receiving your discounts with
California LifeLine renew before...
RESPONSE DATE: 03/22/2017
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JOHN SAMPLE
123 SAMPLE ST
SAMPLE CITY, CA 99999
Keep this sheet for your records.
You can renew online at
using the PIN below
1234
There are two ways for you to renew your telephone discounts from this state program:
OR
For the quickest processing, renew
Mail to:
online at
California LifeLine Administrator
using your PIN.
P.O. Box 8417,
Westminster, CA 92684
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