How Are We Doing?

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

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

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

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   

In the following spaces provided, please tell us:

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?

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.