Market Research Survey

Requested By:

First Last

Your Information

Your Name*

First Last

Email*

Your Age Group

This required for consumer research to determine preferences among generations.

Your Location

State ZIP Code

Do you use an agent or do you purchase online?*

Both
An Agent
Online Only

Did you conduct research online before making your decision to purchase insurance?

No
Yes

SURVEY: Purchased Through an Agent

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

Auto
Home
Second Home
Renters or Condo

Health
Life
Motorcycle
Umbrella

Business Auto
Business Property
Annuities or Financial Services
Recreational

SURVEY: Purchased Direct

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

Auto
Home
Second Home
Renters or Condo

Health
Life
Motorcycle
Umbrella

Business Auto
Business Property
Annuities or Financial Services
Recreational

Satisfaction with Insurance Agent

Primary reason why you chose to purchase through this agent?

How long have you been insured by this agency?*

How often do you communicate with your insurance agents office?*

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?

Overall satisfaction with insurance agency?*

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

Satisfaction with Direct Insurance Carrier

Reason why you purchased direct?

How long have you been insured by this insurance company?*

Overall satisfaction with insurance company?*

Interview Questionnaire

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. This section of the Survey WILL NOT be shown on the survey results to the applicant.

This person loves to help others.

First Choice
Second Choice
Third Choice

This person has exceptional customer service skills.

This person loves to help others.

If hired, would you allow this person the opportunity to quote your insurance business?*

No
Yes
Maybe

Would you recommend this person for this position?*

No
Yes
Maybe

Submit

Are you ready to submit?

Yes
No

Hidden Recruiter Name

First Last

Hidden Recruiter Email

Hidden Applicant Email

Your Information

SURVEY: Purchased Through an Agent

SURVEY: Purchased Direct

Satisfaction with Insurance Agent

Satisfaction with Direct Insurance Carrier

Interview Questionnaire

Submit

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