5060 Avalon Ridge Pkwy
Suite 300
Norcross, GA 30071
Contact: EJ Owens
800-890-2611 x309
770-908-8007 Fax
ejowens@virtucom.com
Digital Dreamers Technology Replacement
Order Form
STEP 1 - Personal Information
Customer's Name:
*
Email Address:
*
Billing Phone Number:
*
Billing Address:
*
City, State
*
Zip Code
*
School Name:
Allgood Elementary School
Arabia Mountain High School
Ashford Park Elementary School
Austin Elementary School
Avondale Elementary School
Barack H. Obama Elementary Magnet School of Technology
Bob Mathis Elementary School
Briar Vista Elementary School
Briarlake Elementary School
Brockett Elementary School
Browns Mill Elementary School
Canby Lane Elementary School
Cary Reynolds Elementary School
Cedar Grove Elementary School
Cedar Grove High School
Cedar Grove Middle School
Chamblee Charter High School
Chamblee Middle School
Chapel Hill Elementary School
Chapel Hill Middle School
Chesnut Elementary Charter School
Clarkston High School
Columbia Elementary School
Columbia High School
Columbia Middle School
Coralwood Diagnostic Center
Cross Keys High School
DeKalb Academy of Technology and the Environment
Dekalb Alternative School
Dekalb Early College Academy
Dekalb Elementary School of the Arts
Dekalb High School of Technology South
Dekalb Path Academy
Dekalb Preparatory Academy
Dekalb School of the Arts
Destiny Acheivers Academy of Excellence
Diverse Learner Services
Doraville United Elementary School
Dresden Elementary School
Druid Hills High School
Druid Hills Middle School
Dunaire Elementary School
Dunwoody Elementary School
Dunwoody High School
E.L. Bouie Elementary School
Eagle Woods Academy
Eldridge Miller Elementary School
Elizabeth Andrews High School
Employment Services
Evansdale Elementary School
Farington Elementary School
Fernbank Elementary School
Fernbank Science Center
Flat Rock Elementary School
Flat Shoals Elementary School
FLEX Academy of Excelence
Freedom Middle School
Globe Academy
Hambrick Elementary School
Hawthorne Elementary School
Henderson Middle School
Henderson Mill Elementary School
Hightower Elementary School
Human Capital Management
Huntley Hills Elementary School
Idlewood Elementary School
Indian Creek Elementary School
International Community School
International Student Center
International Student Screening Center
John Robert Lewis Elementary School
Jolly Elementary School
Kelley Lake Elementary School
Kingsley Elementary Charter School
Kittredge Magnet School
Lakeside High School
Laurel Ridge Elementary School
Leadership Prepatory Academy
Lithonia High School
Lithonia Middle School
Livesy Elementary School
M.L. King, Jr. High School
Marbut Elementary School
Margaret Harris Comprehensive School
Mary McLeod Bethune Middle School
McLendon Elementary School
Midvale Elementary School
Miller Grove High School
Miller Grove Middle School
Montclair Elementary School
Montgomery Elementary School
Murphy Candler Elementary School
Narvie J. Harris Elementary School
Oak Grove Elementary School
Oak View Elementary School
Oakcliff Traditional Theme School
Panola Way Elementary School
Peachcrest Elementary School
Peachtree Charter Middle School
Pine Ridge Elementary School
Pleasantdale Elementary School
Princeton Elementary School
Rainbow Elementary School
Redan Elementary School
Redan High School
Redan Middle School
Robert Shaw Elementary School
Rock Chapel Elementary School
Rockbridge Elementary School
Ronald E. McNair Discovery Learning Academy
Ronald E. McNair High School
Ronald E. McNair Middle School
Rowland Elementary School
Sagamore Hills Elementary School
Salem Middle School
Sequoyah Middle School
Shadow Rock Center
Shadow Rock Elementary School
Smoke Rise Elementary School
Snapfinger Elementary School
Southwest DeKalb High School
Stephenson High School
Stephenson Middle School
Stone Mill Elementary School
Stone Mountain Elementary School
Stone Mountain High School
Stone Mountain Middle School
Stoneview Elementary School
Tapestry Public Charter School
The Champion School
The Globe Academy
The Museum School Of Avondale Estates
Toney Elementary School
Towers High School
Tucker High School
Tucker Middle School
Vanderlyn Elementary School
Wadsworth Magnet School
Warren Technical School
William B. Bryant Center
Woodridge Elementary School
Woodward Elementary School
Wynbrooke Elementary School
*
Student/Teacher Name:
*
Student/Teacher ID:
*
Shipping Address:
*
*
STEP 2 - Order Information
Student Accessories:
Acer Spin 311 Power Adapter
($41.00)
Acer R11 Power Adapter
($21.00)
Acer R11 Chromebook Bag
($7.79)
Acer ChromeTab 10 Power Adapter
($41.00)
Teacher Accessories:
Acer R13 Power Adapter
($36.00)
Acer R13 Chromebook Bag
($9.85)
SubTotal Amount: $0.00
Total Amount: $0.00
STEP 3 - Payment Method (Please pay by either check or credit card)
** Payment must be received by Virtucom to guanrantee delivery on time.
Pay by Check.
(Please make check payable to Virtucom)
Check or Money Order: #
Amount:
$0.00
Pay by Credit Card.
Credit Card:
Visa
MasterCard
American Express
Credit Card #
Exp. Date
Cardholder name
Security Code
Amount:
$0.00
Notes
If you choose to pay by check, you may still submit your order online and mail your check to Virtucom, 5060 Avalon Ridge Pkwy, Suite 300, Peachtree Corners, GA 30071.
Please be sure name, address, and phone # match billing information on your credit card.
All orders will be shipped to the school address.
All technical support requests for the replacement unit are to be submitted to DCSD via the same approved method by DCSD.
Delivery of equipment can be expected to the school within 7-10 business days.
You will receive a confirmation email after you submit your order.
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Certify Acknowledgement
I certify that this purchase is made on behalf of DeKalb County School District (DCSD) pursuant to its policy requiring the parent to be responsible for replacing lost, stolen or damaged property of DCSD. I agree that the replaced property shall be the exclusive property of DCSD and I will abide by all policies and instructions of DCSD regarding the use and return of the replaced property to DCSD. Under penalties of perjury, I declare that I have examined this certification and, to the best of my knowledge and belief, this certification is true and correct and made in good faith, pursuant to the sales and use tax laws for the State of Georgia. This certification is made for the benefit of Virtucom, Inc. 5060 Avalon Ridge Pkwy, Suite 300, Peachtree Corners, GA 30071, a business partner of DCSD.