PAYMENT SELECTION. Please select one of the following payment options, which will be used should you be eligible to receive a settlement payment: PayPal - Enter your PayPal email address: Venmo - Enter the mobile number associated with your Venmo account Zelle - Enter the mobile number or email address associated with your Zelle account: Mobile Number: - - or Email Address: Virtual Prepaid Card - Enter your email address: Physical Check - Payment will be mailed to the address provided above.
PAYMENT SELECTION. The standard Student Laptop protection plan is $25.00 per school year. This amount is reduced for students who requested additional benefits through the free/reduced application. ❏ Standard Payment: $25 full year or $12.50 if student is enrolled Semester 2 only. No refunds will be given. Free/Reduced Additional Benefit: If you were eligible for additional free/reduced benefits in June 2020 and/or submitted a new application and requested additional benefits for the current year, then an adjustment to $12.50 full year will automatically be generated. Repair/Replacement Fees First Claim Second Claim All Other Claims DAMAGE None $25 copay ($15 free/reduced) Full Cost of Repair THEFT (with Police None $100.00 Full Cost to Replace Report) LOST $100.00 Full Cost to Replace Full Cost to Replace Please submit your payment electronically by visiting the school website. If you prefer to pay by check please make checks payable to Sultan School District. Date: I will purchase the Student Laptop Protection Plan. No, I am not purchasing the Student Laptop Protection Plan and agree to cover all repairs and losses during the school year. My child and I have read, discussed and agree to Sultan School District Policy 2022 and reviewed the technology section of our student handbook. Student Name (print): Student Signature: Date: Parent/Guardian (print): Parent/Guardian Signature: Date: This form may be signed electronically using our E-Collect system. Parent/Guardian signature acknowledges student agreement as well. Sultan School District Student Laptop Protection Plan | 2020-21 School Year The educational program at your student’s school includes a Student Laptop that will be issued to your student for their use at school and home. We are very excited to be able to make these powerful tools available to our students. We also understand that both students and parents are concerned about keeping these tools secure and in good working order. Like textbooks, team uniforms and other school property issued to your student, there is a responsibility to take appropriate care of these valuable resources. The Student Laptop is no different, but it does represent an increased cost to the district and liability to students and parents. We know that loss and accidents will happen. District policies, regulations and practices require that a fee be levied to cover the repair or replacement cost of district property. With computing devices, like the Student Laptops, the cost of loss or dam...
PAYMENT SELECTION. If you want to receive an electronic payment, please submit your Claim online.
PAYMENT SELECTION. Please select one of the following payment options: ACH – Enter the information associated with your bank account: Routing Number Account Number Physical Check – Payment will be mailed to the address provided in Section I of this Payment Election Form. RED A DOC LC REV CB OB FOR CLAIMS PROCESSING ONLY
PAYMENT SELECTION. The technology fee is $25.00 per school year. This amount is reduced for students on free/reduced lunch. Please select your payment amount below ❏ Standard Payment: $25 full year. No refunds will be given. ❏ Free/Reduced Eligibility: If a student is currently eligible for free/reduced lunch benefits the cost is $10.00. Eligibility for this reduced price will be verified by November 1. If the student does not meet our criteria for a reduced fee, the additional $15 will be assessed to the student’s account. No refunds will be given.
PAYMENT SELECTION. Please select one of the following payment options, which will be used should you be eligible to receive a settlement payment: PayPal - Enter your PayPal email address: Venmo - Enter the mobile number associated with your Venmo account Zelle - Enter the mobile number or email address associated with your Zelle account: Mobile Number: - - or Email Address: Virtual Prepaid Card - Enter your email address: Physical Check - Payment will be mailed to the address provided above. Were you a Medicare beneficiary during the time period of June 25, 2022 to the present? (check one) □ Yes □ No If you are a Medicare beneficiary receiving more than $750 under this settlement, the Claims Administrator may need to contact you for additional information related to Medicare reporting requirements.
PAYMENT SELECTION. If you would like to elect to receive your Settlement payment through electronic transfer, please visit the website and file your Claim Form online. The Settlement Website includes a step-by-xxxx xxxxx for you to complete the electronic NEWCOURSE COMMUNICATIONS Your claim must be submitted online or postmarked by: DATE CLAIM FORM FOR NEWCOURSE DATA SECURITY INCIDENT SETTLEMENT XXXXX ET XX X. NEWCOURSE COMMUNICATIONS, INC. ET AL. Case No.: 23C303 In the Circuit Court of Davidson County, Tennessee payment option.
