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Please designate your military status

Currently Serving Military Member Veterans/Retirees

Please select a Military Status.

Optional: Are you submitting this form as the spouse of a military member living in the same household? If so, please enter your information below so that we may verify your status.

All * fields must be completed. Please provide your Comcast billing name, address, and phone number associated with your Comcast account number so we can locate your account. Military member must reside at the same residence as the Comcast account. Your account number can be found on your bill statement or by logging on to My Account.

Comcast Account Number *

Please check your account number for accuracy.

First Name *

Please enter a valid first name.

Last Name *

Please enter a valid last name.

Address 1 *

Please enter a valid address.

Address 2

City *

Please enter a valid city.

State *

Please select a state.

Zip *

Numbers only. Format is automatic. Please enter a valid zip.

Phone Number *

Numbers only. Format is automatic. Please enter a valid phone number.

Primary Email Address *

Please enter a valid email address. We will use this email address to send updates on your application, and to deliver your $25 Xfinity coupon.

Please select your branch of the military *

Air Force Army Coast Guard Navy Marine Corps

Please select a valid military branch.

Date of Birth

Numbers only. Format is automatic. Please enter a valid date of birth.

Discharge Year *

Please enter a valid discharge year.

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