Recall – Surge Prescreen Form RECALL PRESCREEN:SubmitORSTART NEW PRESCREEN Searching for Prescreen found. Loading form. No prescreen found. Please try again. YOU MUST FILL IN ALL REQUIRED FIELDS Back Email Results Email Results "> Prescreen Performed By '.$row['first_name'].' '.$row['last_name'].''); } ?> Send copy to member? Date Of Initial Contact By Member: Primary Phone: Alt Phone: Arrester Install Date: Arrester Manufacturer: -- Select Manufacturer -- EFI MeterTreater POU Date: POU Manufacturer: -- Select Manufacturer -- Ahoku EFI TrippLite Date Member contacted by SPD: Left Message Who did you speak with on initial telephone call?: Date of occurrence: Weather Conditions/Special Circumstances at time of occurrence: Clear Stormy Outage Other - Please Explain Damaged items Add Product Field visit required?: Yes No Pending Claim Type?: Arrester POU Both Member advised we will need to see damaged items and take pictutes Member advised to keep all receipts for repair or replacement Comments: Surge Claim?: To Be Determined No Surge Clalm Proceed Wlth Claim Submit Submit Sending
