To submit a request, fill out the form below.

Under federal law, additional documentation will be required to process your request (except in New York State). Please provide any one of the documents listed below:

• A signed affidavit from either: a licensed medical or mental health care provider, a licensed social worker, a victim services provider, or a court employee acting within the scope of employment
• A police report or a document showing statements provided by the police to a court
• A charging document, a protective order, or a restraining order
• Any other official record that documents the abuse

You are not required to provide any additional information to submit a request, such as account numbers or account PINs.

If you need assistance on submitting a mobile line separation request, please fill out the form and select the option “Contact me: I need assistance filling out this form.” For other information and support, contact the National Domestic Violence Hotline at (800) 799-SAFE (7233) or at www.thehotline.org.

Astound has low cost mobile service plans available for low income individuals. If you are in a low-income household, the FCC also makes up-to six months of Emergency Communications Support available through its Lifeline program. Additional information is available on https://cnm.universalservice.org. Astound does not participate in the Emergency Communications Support program.

If you are a survivor of domestic abuse, a caregiver for a survivor, or a designated representative for a survivor, you may use this form to request that Astound separate mobile service lines that you share with an abuser. Astound will maintain the confidentiality of line separation requests and will process them within two business days. If you need assistance in submitting this request, please fill out the form and select the option “Contact me: I need assistance filling out this form” located at the bottom.

PLEASE PROVIDE ALL THE FOLLOWING INFORMATION