Survey Customer Satisfaction SurveyName First Last Business Name or DBAEmail AddressPhoneName of RepresentativePolicy Type(s) You Inquired About or Purchased Auto, Business Auto, Personal Bond Builders Risk Flood Insurance General Liability Home Insurance, Any Products Liability Business Owners Professional Liability (incl. E&O, D&O) Church/Temple Insurance Property/Building Day Care Insurance Restaurant Insurance Disability Vacant Dwelling Workers Compensation 1. Overall ExperienceVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied2. Policy, Binder, Certificate IssuanceVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied3. PromptnessVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied4. Courtesy of RepresentativeVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied5. Knowledge of ProductsVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied6. Responsive to Special NeedsVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied7. Rates & Pricing vs. Other AgenciesVery SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied8. Would you Refer a Friend or Relative to Us?YesMaybeNoI don't have anyI don't speak English9. Product AvailabilityVery SatisfiedSatisfiedNeutralUnsatisfiedVery UnsatisfiedAdditional InformationPlease enter any other comments suggestions or additional information you wish to contribute
