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ChromeCare Quote Request
Client Information
Name
*
First
Last
Position
School District
*
Email
*
Phone
*
Device Information
Quantity of Devices
*
Manufacturer
*
Please select
Acer
Asus
Dell
HP
Lenovo
Samsung
Other
Model
*
Are the Devices New or Existing?
*
Please select
New
Existing
Are the Devices Touchscreen?
*
Please select
Touch
Non-Touch
Do the Devices Go Home or Stay in School?
*
Please select
Stay in School
Go Home
Are the Devices in Cases?
*
Please select
Yes
No
Coverage Term?
*
Please select
1
2
3
4
All Options
Request Another Quote?
*
Please select
Yes
No
Device Information
Quantity of Devices
*
Manufacturer
*
Please select
Acer
Asus
Dell
HP
Lenovo
Samsung
Other
Model
*
Are the Devices New or Existing?
*
Please select
New
Existing
Are the Devices Touchscreen?
*
Please select
Touch
Non-Touch
Do the Devices Go Home or Stay in School?
*
Please select
Stay in School
Go Home
Are the Devices in Cases?
*
Please select
Yes
No
Coverage Term?
*
Please select
1
2
3
4
All Options
How did you hear about us?
*
Notes (or Comments)
