Tech Replace/Repair Fee Form

PARENT/GUARDIAN First name, Last Name

STUDENT First name, Last Name

Campus

Grade

Asset Tag (Blue Sticker)

Fee Types*

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 Palm Rest
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

Cardholder Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

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Event Registration Software by RegFox

NEWMAN INTERNATIONAL ACADEMY

Fee Types*

Billing Information