SURVEY |

Date*

Reference ID:

Survey Type

1=Consumer Research 2=For a Job Interview

Applicant Information

Applicants Name (or referred by):*

First Last

Your Information

Your Name*

First Last

Email*

Address

City State ZIP Code

Do you use an agent or do you purchase insurance direct?*

Direct - GEICO, USAA, eSurance

Agent
Direct
Both

SURVEY: Purchased Through an Agent

From the choices below, which types of insurance do you purchase through an insurance agent?*

SURVEY: Purchased Direct

From the choices below, which types of insurance did you purchase direct from a company like GEICO?*

Satisfaction with Insurance Agency

How long have you had insurance through this agency?*

Less than 1 Year 1-3 Years 3-5 Years 5-10 Years Over 10 Years

Reason why you chose to purchase through your agent:*

Of the reasons identified below, what was the primary reason you choose to do business with that agency.

Referral
Agent is Family or Long Time Friend
Price
Great Service
Trust

How often do you communicate with your current insurance agent?*

Once per Month | Once per Year | Less Than Once Per Year | Seldom if Ever

Seldom if EverLess than once a yearOnce a yearOnce a month

Did your agent provide a professional sales presentation with coverage options when you purchased your insurance policy?*

Yes
No
Not Certain

Does your agent offer to review your insurance policies to make certain you have every discount you are entitled to receive?*

Yes
No
Not Certain

What do you love about your insurance agent, or why do you choose to stay with your current agent?*

What do you wish your agent would improve or do better to service your insurance and financial services needs?*

If you provide a detailed answer that we have not heard and will implement into our agency, you will receive a custom YETI Coffee mug!

Overall satisfaction with current insurance agent.*

1-Very Unhappy | 2-Unhappy | 3-No Opinion | 4-Happy | 5-Very Happy

Satisfaction with Direct Insurance Carrier

Reason why you chose to purchase direct:*

Of the reasons identified below, what was the primary reason why you choose to do business with that agency.

Technology
Convenience
Price
Great Service
Agent's Don't Add Value

How long have you had insurance through this company?

Less than 1 Year 1-3 Years 3-5 Years 5-10 Years Over 10 Years

Applicant Recommendation

The person that referred you to this site may be interviewing for a position in our agency. Based on your relationship with this person, please answer the questions below. Your answers will be confidential.

This person has exceptional customer service skills.*

This person loves to help others.*

If hired, I would allow this person to quote one or more of my insurance policies.*

I would recommend this person for a job in the insurance field.*

Your personal recommendation:

If you would like to provide more details about why you would personally recommend this candidate for hire, please do so below.

Submit Survey

Are you ready to submit?

Yes
No

Would you like a comparison quote from our agency?*

Yes
No thank you.
No, but maybe in the future.

What type of quote would you like us to prepare?

Select all that apply.

Auto
Home
Life
Business
Flood
Motorcycle or Recreational Vehicle
Retirement Planning
College Savings Plan
Other

Address

If you win our drawing, where would you like your gift to be mailed?

Street Address City State ZIP Code

When should we check back with you?

Cell Phone*

Yes

Total: Yes I would Like a Quote

Lead Source

Applicant Survey