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Verizon Connections Program

Please follow the steps below:

Step 1 - Print this form by clicking on the Print button above.

Step 2 - Fax BOTH the form and one of the proof of employment documents below to 1-888-396-1433.

Acceptable Proof of Employment Documents:

Pay stub - A paystub is an accepted method of employment verification in 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.

Employee documentation must include you first name and last name.

Note: You must black out personal information such as your Social Security Number, salary information and bank account information.

Employee Information
*This form must be faxed within 5 days of your online submission.
Employer Name:
{{vm.customerInfo.CompanyName}}
Date:
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Employee First Name:
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Employee Last Name:
{{vm.customerInfo.LName}}
Daytime Phone Number:
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Email Address:
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For Verizon use only
Reference number: {{vm.customerInfo.RefNo}}