Quickstart well pump analysis-online       (Form to start well pump analysis)      *Note, use "Tab" key to go from one field to    another. Hitting "Return" will cause form to    sent to Synergy Tech. prematurely. Procedure:    1) Please fill in all pertinent information (Please use English only).     Date of Loss     Claim Number                    Age of Pump     Motor Make/Model      Adjuster: First Name             Last Name                                            Position                           Company                               Address                                                                                  City                                        State                       Zip Code              Business Phone #        Extension            Fax #                       E-mail Address                   Insured:  First Name                Last Name                                                             Address                                                                                                  City                                         State                   Zip Code                               Phone #             2. Identify other items damaged (ie. pump control box,       home appliances, structural damage, trees, etc. (Based       on your conversation with insured). Ship other items,        such as control box to Synergy Technologies for analysis.       Enter "none" if no other damage occurred.        Entry must be made to start analysis. Fax any        pump installer/service data sheets showing any readings       or observations on damaged pump to 262-377-1974.        (write claim number on sheets).                         3. Choose desired method for pickup from          pull-down menu below: Entry must be made to       start analysis.              Only the picks that include the Quickpickup feature            will trigger a box to be sent by Synergy Tech.    Delivery/Pickup of Pump - Pick method inside this menu. "Quickpickup" from Insured Address ($50 adder - Contig. US) "Quickpickup" from alternate address shown below ($50 adder-Contig. US) Pump will be shipped to Synergy Tech. No box supplied by Synergy Tech. Synergy Tech to pick up pump at above address of insured. Synergy Tech to pick up pump at other address (above).           *If "Quickpickup" method is to be used to pick up       from the insured's residence, notify the insured that a       box will be arriving soon and that the pump needs to be       placed in the box and shipped to Synergy Technologies       immediately. Confirm phone number of insured has been      entered, in case we have to contact insured for whatever      reason. .      If pump is to be delivered to Synergy Technologies, deliver or     ship the pump prepaid (along with control box, if      damaged - packed so as to prevent damage) via carrier to:                                    Synergy Technologies                                N144 W6466 Pioneer Rd.                               Cedarburg, WI  53012                               Email: leslie@synergytech.net        Call Leslie Troedel at 262-546-0032 to discuss, if needed.       .    If pump is outside the contiguous United States, there may be      additional charges. Call or email Leslie Troedel for this information.           4.  Advise alternate location of pickup below, if different than       insured's residence. *Notify someone at the pickup location       that a box will be arriving and that the pump needs to be       placed in the box and shipped to Synergy Technologies      immediately. Provide phone number of pickup location.       Also, include directions if Synergy Technologies is picking      up pump (additional expense). Synergy Technologies will       pick up only in the Milwaukee/Metro area.            5.  Pick from the following three choices: Non-destructive test with full written report. Non-destructive test with verbal or condensed email report. Destructive test with full written report.         Non-destructive (separation only) means that only the      pump wet end will be separated from the motor for testing. When      this separation is done, the pump and motor can be      reassembled to be reasonably the same as the received condition.         Destructive testing means that the motor or pump may be     taken apart such that it may not be able to be reassembled     to the received condition. We can sometimes get more     information if we do destructive testing, you and     the insured forfeit the ability to re-inspect the pump/motor     in the as-received condition. If you choose this option, you     are responsible for getting the insured's approval for this.         (These choices can be changed during the analysis, if a written          report and/or destructive testing is required by contacting          Synergy Technologies and making a request. The manufacturer         can also be invited by you to the destructive testing, although         there may be additional costs)           Entry must be made to start analysis.     Destructive Testing Approval - Pick choice inside Menu $200 option. Clent +insured approves destructive testing with full written report, pump manfufacturer to be present. $200 option. Clent +insured approves destructive testing with full written report, do testing without pump manfufacturer present. $200 option. Do not do destructive testing. Separaton of motor and pump (wet end) only is approved with full written report. $150 option. Do not do destructive testing. Call with verbal or brief email report .         6. Print this form for your records.       7. Submit this form to Synergy Technologies by clicking     the "Submit" button below (Clicking the submit button     indicates that client understands that Synergy Technologies      will discard pump 30 days after date of email report sent      to client. Client is responsible to advise Synergy Technologies      (within 30 days of email report) if pump is to be returned      to insured .        8. If pump is to be returned after analysis, please advise      address to which pump is to be shipped. Do not submit P.O.     Box, as UPS or other carriers will not deliver to a P.O. Box.     The cost for returning a pump is $30.           The pump will then be tested and an email report sent      within 5 business days after the pump has been received.      Also, please let us know how you found out about our service by    choosing one from the menu below:      Entry must be made to start analysis.    How did you find about our testing service? Word of mouth Claimspages.com ARManual.com Casualty Adjusters Guide Synergy Tech. contact or brochure Synergy Tech website I am a previous client. Other, specify below      If you choose "Other", please let us know how:        Print out this form, for your records.       Look for a an email response from us within one business     day (regarding the box being sent). If you do not receive an    email within 1 day, please call Leslie to see if there     were any internet problems with this form.                                  After the job has been entered and the box has been sent, you can track your box or well pump by clicking the UPS Tracking link below and inputting either tracking number sent to you by Synergy Technologies. This link is found on the "Start Analysis" and "Lightening Analysis" web pages. http://www.ups.com/tracking/tracking.html