Survey Form

Yours is our most important business! Please take a few minutes to tell us how
to make our service to you even better!

Please check one box for each

For the following five questions, please check "YES" or "NO". (If "YES", please explain)

In the following spaces provided, please tell us:

PLEASE CHOOSE THE BEST ANSWER

Convenient office hours:	Excellent Fair Poor
Convenient office location:	Excellent Fair Poor
Polite telephone response:	Excellent Fair Poor
Prompt phone call return:	Excellent Fair Poor
Insurance coverage selection:	Excellent Fair Poor
Prompt policy delivery:	Excellent Fair Poor
Competitive price structure:	Excellent Fair Poor
Easy-to-read correspondence:	Excellent Fair Poor
Easy-to-read policies:	Excellent Fair Poor
Easy-to-read invoices:	Excellent Fair Poor
Professional sales people:	Excellent Fair Poor
Responsive customer service:	Excellent Fair Poor
Prompt inquiry response:	Excellent Fair Poor
Timely renewal notices:	Excellent Fair Poor
Prompt insurance reminders:	Excellent Fair Poor
Frequent enough contact:	Excellent Fair Poor
Prompt claim response:	Excellent Fair Poor
Professional claim handling:	Excellent Fair Poor
Fast, fair claim settlement:	Excellent Fair Poor
Timely written confirmations:	Excellent Fair Poor

PLEASE CHOOSE YES OR NO

Should additional services be made available?	Yes No
Should additional products be made available?	Yes No
Should our service structure be changed?	Yes No
Should our service days or hours be extended?	Yes No
Would you prefer more frequent contact or coverage reviews?	Yes No

PLEASE TELL US YOUR OPINION

What you Most Like about doing business with us:
What you Least Like about doing business with us:
Briefly, what is the Most Important Improvement you would like us to make?

PERSONAL INFORMATION

Name:
Address:
City:
State:
Zip:
Please check here if you would like a call from us:
Phone Number:

Thank you very much for taking the time to tell us about our agency.
Please be assured that we take your critique and suggestions very seriously.
As we stated at the outset, YOU ARE OUR MOST IMPORTANT BUSINESS.

Quotation Forms

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