EBT Customer Support Contact Request Form

EBT Customer Support Contact Request Form
Use this form to request assistance with your EBT-related account or service issues. A support representative will review your request and contact you as soon as possible.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Contact Method
State or Region
Type of EBT Issue
Brief Description of Your Issue
When did the issue begin?
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Best Time to Contact You
Have you contacted EBT customer service before about this issue?
If you have a reference or case number, please provide it here (optional)
Should be Empty: