Technology Order Form

Technology Order Form
You may use this form to order iPad Chargers, screen protectors, or pay for iPad incident Deductible.
Name:

PrefixFirst NameLast Name
Student Name:

First NameLast Name
Student Grade:
E-mail:
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number

Pay iPad Deductible for Incident$50.00

Apple Certified Lightening Cable$6.00

iPad 12w Charging Block$6.00

iPad Screen Protector$10.00

Total $0.00