Upload
darrin-carnahan
View
208
Download
0
Embed Size (px)
Citation preview
Name of Insured:*
Grade Level:*(For student policy only)
Parent Name:*(For student policy only)
Mailing Address:*
City, State/Zip:*
Home Phone:* Cell Phone:
Email:*(Policy Documents are emailed)
Select Policy Option
Coverage Period
Coverage Amount
Deductible Total Cost
Your School, Evansville Vanderburgh School Corporation (Evansville, IN) is passing out Netbook insurance forms provided by Worth Ave. Group to insure school issued Netbooks given to students, teachers and staff. Insurance with Worth Ave. Group will protect the Netbook against: theft, vandalism, fire, flood, natural disasters and power surge due to lightning strikes. This Netbook policy will provide replacement cost coverage and protect the Netbook worldwide (on and off
school grounds).
K‐12 Netbook Insurance Plans
School Year 2012‐2013
K‐12 Netbook Insurance Application
$28 00
Option 1 1 Year $525 $100 $25.00
O ti 2 1 Y $525 $50
To receive this special rate for online purchase use discount PROMO CODE:
PLEASE TYPE OR PRINT * REQUIRED FIELDS
My check is enclosed (Make check payable to Worth Ave. Group)
Please charge my credit card
Account Number:
Exp. Date (mm/yy): CCV#:
$28.00Option 2 1 Year $525 $50
$39.00
Option 3 1 Year $525 $25 $29.00
Option 4 1 Year $525 $0
Use Promo Code evsc for discount BB on August 17th, 2012 ‐ N
evsc
Select Laptop/Tablet policy P.O. Box 2077Stillwater, OK 74076
8am‐5pm Monday ‐ Friday CSTSelect Yes when asked if this is a K‐12 policySelect a deductible For Office Use Only
HOW TO OBTAIN COVERAGEONLINE MAIL PHONE
https://my.worthavegroup.com/evsc Worth Ave. Group 1 (800) 620‐3307