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
Polite Service Technician:	Excellent      Fair      Poor
Prompt policy delivery:	Excellent      Fair      Poor
	Excellent      Fair      Poor
	Excellent      Fair      Poor
	Excellent      Fair      Poor
Easy-to-read invoices:	Excellent      Fair      Poor
Professional consultant:	Excellent      Fair      Poor
Responsive customer service:	Excellent      Fair      Poor
Prompt inquiry response:	Excellent      Fair      Poor
Timely renewal notices:	Excellent      Fair      Poor
Newsletter:	Excellent      Fair      Poor
Frequent enough contact:	Excellent      Fair      Poor
	Excellent      Fair      Poor
	Excellent      Fair      Poor
	Excellent      Fair      Poor
	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?

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Name:
Address:
City:
State:
Zip:

Please check here if you would like a call from us:

Phone Number:

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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.