Verizon ConnectionsVerizon Connections

Discount Eligibility Form

Please complete the form below. If we find your employer in our systems, you will be given the option to fax or
upload us a copy of your proof of employment.

Please have one of the following proof-of-employment documents ready:

Pay stub - a paystub is an accepted method of employment verification in for all participating companies. The document must be clearly legible when scanned or faxed. The paystub must include the name of your employer, your name and it must be dated within the last 60 days. Please black out all other personal information, including your salary information, taxes, social security number, etc.

Employee badge - Do not send a badge copy unless you have been instructed to do so in the communication regarding the Verizon Connections Program. Very few employers have agreed to badge validation. If we do not have a sample badge, approved by your employer on file, your submission will be rejected.

Employer Information
Fields marked below with (*) are required.

Employee Information

Verizon Connections: Discounts on qualifying packages available to qualifying persons. Standard bundle and other agreements, eligibility restrictions & additional terms apply. Verizon Connections program and amounts are subject to change and may be modified or discontinued at any time.