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Chromebook Repair and Insurance Claim

Technology Fines Form

Please complete the form below. Required fields marked with an asterisk *

Student ID Number*

For multiple students, please list student ID's separated by comma(s). For Example (12345678, 87654321)

Answer Required

Quantity

Insurance Purchase

Price: $20.00

Quantity

Insurance Claim #1

Price: $20.00

Quantity

Insurance Claim #2

Price: $40.00

Quantity

Screen Replacement

Price: $24.00

Quantity

Keyboard Replacement

Price: $62.00

Quantity

USB-C AC Power Adapter

Price: $32.00

Quantity

Chromebook Total Loss

Price: $300.00

Confirmation Email

Confirmation Email *

Email Required