WMIR Survey Questionnaire

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WMIR Survey Questionnaire

Your opinion matters—complete a brief survey and earn a $25 gift certificate from WMIR.

Email *

What year was your home built? *

What county do you live in? *

Have you experienced these concerns inside your home? *

Black Grout

Wet Ceilings or Walls

Wet Damaged or Buckling Floors

Soft Drywall

Visible Green or Black Mold

Loose, Raised or Sunken Tiles

Stains on Walls or Ceilings

Bubbling Paint

AC Clogs or Leaks

Unidentified Foul Odor or Smell

Other:

Required

Have you ever updated or remodeled your home? *

Yes

Other:

Have you ever had to file a home insurance claim before? *

Yes

Other:

Are you apprehensive about dealing with your insurance company? If so, why? *

Fear of Complex Process

Fear of Premium Increases

Fear of Insurance Dropping You

Other:

Required

What concerns, if any, made you reluctant to contact us? *

What is your full name, and what is the best number to reach you to redeem your $25 gift certificate?
*

A copy of your responses will be emailed to the address you provided.

Submit

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