Thank you for taking the time to come and fill out this quick and simple customer survey.

Survey
	Please enter the survey code provided on your letter.
	Please answer Yes or No to the following:
	Has your address changed since your last renewal?	Yes No
	Do you have any detached structures or separate garages?	Yes No
	Do you own or rent any other real estate, by yourself or with others?	Yes No
	Have you done any remodeling or made other improvements to your home?	Yes No
	Do you conduct business at home?  Business as defined by the IRS is anything that you receive financial gain and/or expect to receive financial gain.	Yes No
	Do you own tools, equipment or other property used in your trade, business or profession?	Yes No
	Do you own expensive jewelry, furs, firearms or silverware?	Yes No

	Please answer the following based on your customer service experience:	Very Satisfied	Somewhat Satisfied	Fairly Satisfied	Very Dissatisfied	Completely Dissatisfied

	Overall, how satisfied are you with the insurance service you receive from us?	5 4 3 2 1
	Does the Charter staff give you the information that you need?	5 4 3 2 1
	Is the Charter staff friendly and professional?	5 4 3 2 1
	Are we prompt in meeting your needs?	5 4 3 2 1
	Did you recently speak with someone directly from Charter?	Yes No
	Were you satisfied with the timeliness and accuracy of the representative helping you?	5 4 3 2 1

	What can we do to serve you better?
	Is there anything you would like to say to The President of Charter Insurance?

	Would you like us to contact you with more information about any of our Banking, Mortgage, Insurance or Financing products or services? (Please check all products or services you want further information on.)
	Personal Insurance (Life or Health) Credit or ATM cards Commercial Insurance CD's, Money Market Checking Accounts Individual Retirement Account (IRA) Savings Account Consumer Loans (Home Equity, etc.) Commercial Checking Account Construction Loan Home Mortgage Commercial Loan Lot Loans Commercial Real Estate and Mortgage Loan Stock, Bond, Mutual Funds
	Thank you for choosing Charter Insurance Services as your insurance provider!

About You
	Optional Information Please complete if you wish to receive more information or would like a response.
	First Name:
	Last Name:
	Phone Number:
	Email:
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	How do you prefer that we contact you? Please Select Email Phone Mail
	Disclaimer-Any coverage change requested on this survey/check-up is not bound or covered until the request is verbally requested and confirmed by the insured and the agency.