District 140 Tech Dept Invoice SAMPLE
This form is intended for internal use only.
* Required
Student First Name
*
Your answer
Student Last Name
*
Your answer
Building
*
Choose
Davenport Elementary
Goodfield Elementary
Congerville Elementary
Eureka Middle School
Eureka High School
Chromebook Number
*
Your answer
Chromebook Model
*
Samsung
EduGear
N22
100e
HP Chromebook 11
Item 1
*
Choose
Device Replacement
Screen Replacement
Charger Replacement
Keyboard Replacement
Individual Key Replacement
Battery Replacement
Screen Bezel Replacement
School Warranty Repair
New Student Enrollment
Reclaimed Screen
Reclaimed Charger
Reclaimed Keyboard
Manufacturer Warranty Repair
Other (See Below)
Logic Board Replacement
Device Purchase (Senior Only)
Are there more than one repairs?
Yes
No
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