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Customer Satisfaction Survey
Please take a moment to let us know where we can improve and what we are doing right.
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* Indicates required question
Would you recommed our agency to your friends, family, and collegues?
Yes
No
Other:
Clear selection
If no, please tell us why not.
Your answer
Who do you usually speak with when contacting our agency.
Allen Hardy
Ben Hardy
George Burnett
Jay Eubanks
Jimmy Files
Jodi Harrison
John King
Kay Kilpatrick
Kelly McLain
Lisa Johnston
Martha Pilgrim
Rachel Cherry
Scott Hines
Stephanie Gray
Susan Bobo
How would you rate the service you usually receive
1 being the worst and 10 being the best
Worst
1
2
3
4
5
6
7
8
9
10
Best
Clear selection
How would you prefer to be contacted by our agency?
Home Phone
Cell Phone
Email
Text Message
Postal Mail
Other:
Would you be interested in someone contacting you about other types of coverage we offer?
Yes
No
Clear selection
Did you know you can be entered for a chance to win $25 monthly and $500 at the end of the year for making a referral?
Yes
No, please tell me more.
No, I don't like free money and I'm not interested.
Clear selection
Please tell us how we can better serve you in the future.
Your answer
Name
*
Your answer
Address
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Your answer
City
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Your answer
State
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ME
MD
MA
MI
MN
MS
MO
MT
NE
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NY
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ND
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OR
PA
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Option 43X
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Zip
*
Your answer
Phone Number
Your answer
Email Address
*
Your answer
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