Personal Information

*Required Fields

*First Name of Parent or Guardian on the Account

*Last Name of Parent or Guardian on the Account

*Address 1

Address 2

*City

*State

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*Zip Code

*Country

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*Phone Number of Parent or Guardian on the Account

*Contact Email

If you qualify for reimbursement, you will be issued a check from our customer service partner, Stericycle, sent to the mailing address that you provide in the claim form.
 

In most cases, the expected time for you to receive your reimbursement is 4 – 6 weeks from the date of the claim form submission.

 

Click here for FAQs

 

Click here for Terms and Conditions

*Terms and Conditions

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2020

:  doki