THE ORDER APPLIES TO:

Wireless service provider (name):

Current account holder (name):

Billing telephone number:

New account holder (name):

Fill in court name and street address:

Superior Court of California, County of

Transfer of the following wireless phone number(s):
Telephone number (include area code):
Telephone number (include area code):
Telephone number (include area code):
Telephone number (include area code):
Telephone number (include area code):

Fills in case number:

Case Number:

Check box to include attachment with additional telephone number(s).

TRANSFER OF RIGHTS AND RESPONSIBILITIES
All rights and responsibilities for the accounts listed in      , including all financial responsibility for the telephone 
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numbers, monthly service costs, and costs for any mobile device associated with the telephone numbers, must be 
immediately transferred to the new account holder (person in      ).
The person in      will be financially responsible for the accounts listed in       starting:

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the date the account is transferred by the wireless service provider
(specify date)

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The person in       must send this order and a completed copy of form DV-901 to the wireless service provider listed 
in      . For information on where to send this form and Form DV-901, go to the following website:  
http://www.sos.ca.gov/registries/safe-home/domestic-violence-wireless-plans. Form DV-901 is a confidential form 
and must NOT be filed with the court.

Date:

Judicial Officer

ATTENTION WIRELESS SERVICE PROVIDER
The new account holder’s (person in      ) contact information, including information on form DV-901, must NOT be 
disclosed to the current account holder (person in      ). 

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This order is made under California’s Domestic Violence Prevention Act.

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DV-900

Order Transferring Wireless Phone 
Account

Clerk stamps date here when form is filed.

TO THE WIRELESS SERVICE PROVIDER: This order is made under 
California Family Code section 6347. 

This is a Court Order.

Judicial Council of California, www.courts.ca.gov 
New July 1, 2016, Mandatory Form   
Family Code, § 6347

 Order Transferring Wireless Phone Account 
(Domestic Violence Prevention)

DV-900, Page 1 of 2

Case Number:

INSTRUCTIONS FOR WIRELESS SERVICE PROVIDER
The orders contained on page 1 of this form must be followed unless the wireless service provider cannot operationally or 
technically effectuate the order due to certain circumstances, including, but not limited to, any of the following:

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When the current account holder has already terminated the account

When differences in network technology prevent the functionality of a device on the network

When there are geographic or other limitations on network or service availability

If the provider determines that transfer CANNOT occur, then the provider MUST notify the person in      within 72 
hours of receipt of this order (California Family Code section 6347).

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(Clerk will fill out this part.)

—Clerk's Certificate—

Clerk’s Certificate 
[seal]

I certify that this order is a true and correct copy of the original on file in the 
court. 

 Date:

Clerk, by

, Deputy

 New July 1, 2016

 Order Transferring Wireless Phone Account 
(Domestic Violence Prevention)

DV-900, Page 2 of 2

This is a Court Order.