PA Franklin Regional School District

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PA Franklin Regional: FRSD Device Insurance

Step 1 of 1

* Denotes a required field

Students First Name*

Students Last Name*

Grade level*

Parent/Guardian Name*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

Payment Amount*

Single Device: $35.00

Family Device Fee: $70.00

Please Do Not Complete The Following Field

Note: To continue, please click CHECKOUT. Entering your e-mail on the next page will generate an e-mailed receipt from this transaction.