Sample collection complete!
The ITEL report will be returned to your adjuster the next business day after we receive
the sample. For questions on the results or your claim, please contact your insurance adjuster. If you
need help with these instructions, call ITEL’s Customer Service Team: 800-890-ITEL (4835) Monday - Friday,
8:00 AM to 9:00 PM Eastern Time. You can also e-mail our team: customerservice@itelinc.com.
page 2 of 2
Send the sample
If the sample is wet, enclose the form in a ziplock-style bag before shipping.
Place the form and sample in a sturdy shipping envelope or box, attach the label, and
seal the package. Express Pak envelopes are available free at UPS Stores®. You can
drop
the sample off at a UPS drop box or take it to a UPS
Store. Drop box and store
locations are available at www.ups.com/dropoff. If using your own shiping, send
the
sample to:
ITEL Laboratories
6676 Corporate Center Pkwy
Suite 107
Jacksonville FL 32276
The top part of the peel-and-
s
tick label should be placed on
the envelope.
If you have downloaded the
label, you will need to tape the
label to your package using
clear packing tape.
The bottom part is your
return receipt. It includes
the UPS
tracking number
and should be kept for
your records.
Downloaded labels will
not have the return
receipt; please keep a
copy of your tracking
number for reference.
Step 3: Ship the sample using the pre-addressed UPS® label
Need a shipping label? Download a shipping label at itelinc.com. There is no need to pre-pay the
shipping when using the ITEL
shipping label.
Billing
As your adjuster instructed
you to submit the sample,
there is no charge for the
analysis. Make sure to
complete all fields under
“Insurance Company .”
Your form may be slightly different than the
example.
Step 2: Fill out the “Homeowner’s Test Request Form”
Complete the Test Request Form.
All information is required
except where noted.
1. List your information.
2. List insurance company
information
3. Check appropriate box
for enclosed sample.
6745 Philips Industrial Blvd.
Jacksonville, FL 32256
Phone: 800-890-ITEL (4835)
Fax: 904-36
3-2379
www.it
elinc.com
HOMEOWNER'S FLOORIN
TEST REQUEST FORM
BEFORE SENDING MAKE SURE YOU...
1. Enclose this form in a sealed plastic bag if the sample is wet.
2. Send t
he cleanest, least damaged sample possible.
3. Collec
t the flooring based on the instructions in the kit.
4. Comple
tely fill out your contact and insurance company
inform
ation.
Today's Date: _________________________________
Date Damage Occurred: ______
___________________
Homeowner Information (All fields are required)
Homeowner's Name:
___________________________________________________________________
Phone #:
___________________________________________________________________
Fax # or E-mail Address:
___________________________________________________________________
City, State, and Zip Code
(Damaged house):
___________________________________________________________________
Insurance Company (All fields are required)
Insurance Company:
___________________________________________________________________
Claim Number:
___________________________________________________________________
Adjuster Name:
___________________________________________________________________
Adjuster Phone Number:
___________________________________________________________________
Adjuster Fax # OR E-mail:
___________________________________________________________________
SSaammppllee EEnncclloosseedd ((IInncclluuddee oonnee ffoorrmm ppeerr fflloooorriinngg ssaammppllee))::
Flooring
Description: ___________________________________________
Room(s): ______________________________________________
Pad or underlayment (free test if sent with flooring sample)
Description: ____________________________________________
Ro
om(s): ______________________________________________
SAMPLE REQUIREMENTS:
Flooring:
1.
Carpets should be 10" x 10"; pads should be 6"
x 6". Smaller samples may affect accuracy.
2. Sheet and tile vinyl should be at least 2" x 2".
3. Send the full width and 10" of length for
laminate, wood, and vinyl plank. If the full width
is not a
vailable, note it on the form.
4. Review the instructions before sending.
BBIILLLLIINNGG
As the adjuster has instructed you to send the sample as part of the claim settlement process, the test will be billed to your insurance
carrier. Complete all fields in the Insurance Company section above.
QQUUEESSTTIIOONNSS?? Please contact our Customer Service team at 800-890-ITEL (4835) or custserv@itelinc.com.
Rev. 08/08
Homeowner’s Guide: Homeowner’s Guide: Submi�ing Samples Submi�ing Samples page 2page 2
