Requesting Line Separation Under the Safe Connections Act
At Breezeline Mobile, we are dedicated to supporting the safety and independence of survivors (as defined below under “Survivor”) of domestic violence, dating violence, sexual assault, or other related crimes and violence (as defined below under “Covered Act”). Under the Safe Connections Act, you have the right to separate your mobile phone line, as well as the lines of your dependents, from an account shared with an abuser without incurring any penalties or fees.
How to Request a Line Separation
Requesting a line separation is a straightforward process. Please follow these two simple steps. We are here to help you maintain your privacy and ensure your communications remain secure.
Step 1: Documentation Requirements
To process your request we will need the following documents. We understand that gathering these documents may be challenging, but they are necessary to ensure we can process your request swiftly and securely.
Please attach documentation verifying that the person you are sharing a mobile services account with has committed or allegedly committed an act of domestic violence, trafficking, or another “Covered Act” against you. The documentation provided should clearly indicate your name and a known name for the abuser.
Acceptable documentation includes:
A copy of a signed affidavit from a licensed medical or mental health care provider, licensed military medical or mental health care provider, licensed social worker, victim services provider, licensed military victim services provider, or an employee of a court, acting within the scope of that person’s employment; or
A copy of a police report, statements provided by police, including military or Tribal police, to magistrates or judges, charging documents, protective or restraining orders, military protective orders, or any other official record that documents the covered act.
If you are seeking separation of the line(s) for any individual under your care, include an affidavit signed and dated by the individual under your care, stating that the individual is in your care and uses the specific line.
Step 2: Line Separation Request
Send the documentation gathered above as well as the form below in an email to [email protected]. If you prefer, you can also provide the information verbally to one of our dedicated support agents at 855-214-6014 and only email the supporting documentation. Once we receive your request, our team will verify it. If the request is complete and all the requirements are met, then we will try our best to separate the line(s) within 2 business days. We may contact you to confirm the details of the line separation request, or to inform you if we are unable to complete the request.
—-------- Please copy and paste the following form —--------
Personal Information
First name (of the survivor):
Last name (of the survivor):
First name of the abuser:
Last name of the abuser:
Breezeline Mobile Number of the survivor:
Breezeline account number (optional):
- Preferred contact method for the survivor (optional):
Phone number:
Email address:
Other:
Details of the Designated Representative (if applicable)
If you are a designated representative making a request on behalf of the survivor, indicate your name, phone number and email address below.
First name of designated representative:
Last name of designated representative:
Mobile Number of the designated representative (optional):
Email address of the designated representative (optional):
Type of request: Line Separation
Details of the lines to be separated
Line 1:
Mobile Number:
User’s First and Last Name:
Is this line used by you? Yes/no
Is this the abuser’s line? Yes/no
Is this the line of someone in your care? Yes/no
Plan requested (you can keep your existing plan with promotional terms, or choose from any of the available plans at mobile.breezeline.com):
Line 2 (for additional lines please copy and paste the following questions):
Mobile Number:
User’s First and Last Name:
Is this line used by you? Yes/no
Is this the abuser’s line? Yes/no
Is this the line of someone in your care? Yes/no
Plan requested (you can keep your existing plan with promotional terms, or choose from any of the available plans at mobile.breezeline.com):
Please note that there is no limit on the number of lines you can request for separation.
Acknowledgment
By typing my name below, I state that I am requesting relief from Breezeline Mobile under section 345 of the Communications Act and the FCC rules, and certify that the information provided is true and accurate to the best of my knowledge and that the documentation provided is legitimate.
Name:
Date:
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Support and Assistance
We understand this is a difficult time, and we are here to assist you. For immediate help or further assistance with the line separation, please contact us at:
Phone: 855-214-6014
Email: [email protected]
Important Information
We will separate your line from an abuser without charging any penalties or fees, or imposing any other requirements on limitations. Note that you will assume financial responsibility for the monthly service costs for your separated phone number(s). If you were the account owner, we may not prorate the current month’s bill for the separation of the abuser’s line if the line separation occurs in the middle of the billing cycle. Any previously accrued arrears on an account following a line separation will stay with the person who was the primary account holder prior to the line separation.
Lifeline Program Support
You may be eligible for Lifeline support. However, Breezeline Mobile is not part of the Lifeline Program (other service providers may support it). More information can be found at Lifelinesupport.org or FCC.gov/general/lifeline-program-low-income-consumers.
Additional Resources
Definitions:
“Covered Act” includes domestic violence, dating violence, sexual assault, stalking, and sex trafficking, abuse in later life, child abuse and neglect, child maltreatment, economic abuse, elder abuse, female genital mutilation or cutting, forced marriage, and technological abuse.
“Survivor” is an individual who is at least 18 years old, and against whom a covered act has been committed, or who cares for another individual against whom a covered act has been committed (such as same household members, parents/guardians of minor children, those with court order/power of attorney, or a caretaker over the financially or physically dependent adult).
For more information about the Safe Connections Act and other support services, please visit:
FCC Safe Connection Act Information
National Domestic Violence Hotline
The National Sexual Assault Hotline
Privacy and Safety Notice
The information you provide to us is CONFIDENTIAL and will be disposed of within 90 days of receiving the request, unless we are instructed otherwise by law enforcement. Internet usage can be monitored and is difficult to erase completely. If you're concerned about monitoring, please clear your browser history after visiting our site.