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NEWMAN INTERNATIONAL ACADEMY

Technology Repair/Replace Fee Form

2024-2025

PARENT/GUARDIAN First name, Last Name*

STUDENT First name, Last Name*

Campus*

Grade*

Asset Tag (Blue Sticker)*

Fee Types*

Chromebook Touchpad
Price $15.00
Select Damage Type
Chromebook Upper Chassis
Price $20.00
Select Damage Type
Chromebook Lower Chassis
Price $20.00
Select Damage Type
Chromebook AC Charger
Price $25.00
Select Damage Type
Chromebook Screen
Price $40.00
Select Damage Type
Chromebook Battery
Price $40.00
Select Damage Type
Chromebook Keyboard
Price $75.00
Select Damage Type
Chromebook Motherboard
Price $130.00
Select Damage Type
Chromebook Lost/Totaled
Price $300.00
Select Damage Type

Total

$0.00

Billing Information

Email*

Cardholder Name*

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Mobile Phone Number*

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