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Device Damage Invoice

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

Student's Full Name*

Answer required for "Student's Full Name"

Student Grade Level*

Answer required for "Student Grade Level"

Parent's Full Name*

Answer required for "Parent's Full Name"

Parent's Main Phone Number*

Number Required

Damages

Answer required for "Damages"

Damaged/Cracked Screen ($50.00)

Missing Keys ($25.00)

Lost Adapter ($40.00)

Hotspot ($89.00)

Replace Chromebook ($450.00)

Other

Total Amount Due:*

Answer required for "Total Amount Due:"

Invoice Number

Answer required for "Invoice Number"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"