http://usedcellphones.com/contactus/phonerequest.cfm

I understand and agree that:

not all persons that submit this form will receive a free emergency phone
that the 911 emergency cell phones given away are dependant on what we have in stock
that usedcellphones.com, LLC is not responsible for the 911 cell phone's maintenance
that usedcellphones.com, LLC can share the information above with other charitable organizations that help distribute 911 emergency cell phones.