Access Enrollment Form

Blue Duck Equitable Access

Please complete this form if preferred to enroll or learn more about your options.
  • Please enter your full name as registered in the app, must be a reasonable match to verifying documents.
  • Please enter the email address preferred for your Blue Duck account.
  • Please enter the phone number preferred for your Blue Duck account.
  • Please select your Blue Duck market.
  • Please select the topic you're interested in learning more about.
  • If interested in our discounted program, please upload proof of eligibility here. Individuals who qualify for local, state, or federal assistance programs are eligible to participate in this program will receive a 50% discount. Those who qualify may submit proof of eligibility to Blue Duck. Examples of eligible documents prove enrollment such as a photo or scan of your card, discounted utility bill, insurance or reduced fare card (including Medicaid, LIHEAP, SNAP, WIC, EBT, etc..)
    Drop files here or
    Accepted file types: jpg, png, pdf, gif, Max. file size: 64 MB, Max. files: 5.
    • Please provide a photo of government-issued identification, including your name. This should match the name on your proof of assistance documentation.
      Drop files here or
      Accepted file types: jpg, png, pdf, gif, Max. file size: 64 MB, Max. files: 5.