Once you've chosen your preferences, click on preview and it will show up on the screen at the right. You can crop the picture down to eliminate non-essential information. If you like how the image scanned (not twisted or out of focus), then click next.
You'll now see Picture Name and Destination. Here is where you'll name your scanned image, choose a format (.jpeg, etc.) and location where the image is to be sent. You can see I scanned the 4th ornament in the Spellbinders 2011 Heirloom Ornaments and had it sent to the Spellbinders folder.
Just follow the wizard from there on.