Thank you for your interest in Reconnect’s hardware programs. Please fill out the form to submit your hardware request. "*" indicates required fields Facility Name* Primary Contact Name* First Last Primary Contact Phone*Primary Contact Email* Shipping Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How many phones would you like?*Which phone plan would you like?* Plan A: Reconnect Only Mode: The phone will only run the Reconnect Community app. No calls, texts, apps, or web access are allowed. Plan B: Reconnect Select Mode: Device has call & text functionality, internet access, and allows other apps to be installed. Jurisdiction has full control over installed apps, and calls can be limited to specific numbers if desired. Should participants be able to make and receive phone calls?* Yes No Should participants be able to make and receive text messages?* Yes No What apps should be preinstalled for participants to have access?* Zoom In the Rooms Pexip Indeed Google Maps Web browser Clock Lyft Uber None of the above Other What other apps would you like to be available?Our default service provider is Verizon. Would that be a problem in your area?* Yes No Please explain why Verizon would not work for your program/participants.*Is this a replacement phone?* No Yes Will this order be replacing lost or damaged devices? Phone plans for lost of damaged will be cancelled shortly after receiving the request. Please return damaged devices to Reconnect.Lost Device(s) ID*Enter the device ID(s) from the sticker on the back of the device.A per-device fee will be invoiced upon receipt of your order. Lost, damaged, or unreturned devices are subject to fees. Please refer to the Cell Phone Lease Program Policy for complete terms. For more information on Reconnect's phone lease program, please reach out to support@reconnect.io.Agree?* I understand
