New Customer Activation Form

Welcome to Helix Wireless. In order to ensure a great customer experience, please complete this form and send it back to your Helix Wireless contact.

Street Address, City, State and ZIP Code ( Include Apt or Suite)

Select or enter value
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Select or enter value
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First Line

Provide number if porting or type "Request New Number" to

Provide Account number and Transfer PIN (if applicable)

If different then New Account Information provided above

Street Address, City, State and ZIP Code ( Include Apt or Suite)


if different from the above

Provide Device Name and Model Number(s) wanting to order

Provide IMEI of your existing device

Select or enter value
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Second Line

Provide number if porting or type "Request New Number" to

Provide Account number and Transfer PIN (if applicable)

If different then New Account Information provided above

Street Address, City, State and ZIP Code ( Include Apt or Suite)


if different from the above

Provide Device Name and Model Number(s) wanting to order

Provide IMEI of your existing device

Select or enter value
Caret IconCaret symbol

Third Line

Provide number if porting or type "Request New Number" to

Provide Account number and Transfer PIN (if applicable)

If different then New Account Information provided above

Street Address, City, State and ZIP Code ( Include Apt or Suite)


if different from the above

Provide Device Name and Model Number(s) wanting to order

Provide IMEI of your existing device

Select or enter value
Caret IconCaret symbol

Fourth Line

Provide number if porting or type "Request New Number" to

Provide Account number and Transfer PIN (if applicable)

If different then New Account Information provided above

Street Address, City, State and ZIP Code ( Include Apt or Suite)


if different from the above

Provide Device Name and Model Number(s) wanting to order

Provide IMEI of your existing device

Select or enter value
Caret IconCaret symbol

Fifth Line

Provide number if porting or type "Request New Number" to

Provide Account number and Transfer PIN (if applicable)

If different then New Account Information provided above

Street Address, City, State and ZIP Code ( Include Apt or Suite)


if different from the above

Provide Device Name and Model Number(s) wanting to order

Provide IMEI of your existing device

Select or enter value
Caret IconCaret symbol

Confirmation of Terms and Condition

Terms and condition can be found in the "Helix Hub" - Employee Handbook