PROVIDER INSURANCE: RENEWAL SURVEY FOR AUTO

1. Provider's Policy Renewal Survey - Auto

Is your insurance policy up for renewal? If so, please take a moment to complete this two minute survey so that we can get right to work on saving you money. Does the Provider Insurance Group write all of your personal insurance policy’s? Did you know there are companion discounts when writing all of your coverage with one company?

If you are taking this survey because you received our voice mail message, Thank you! Your responses will give us the tools we need to help keep you properly protected, at the right price.

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1. YOUR NAME:

YOUR NAME:

2. ENTER YOUR PREFERRED EMAIL ADDRESS:

ENTER YOUR PREFERRED EMAIL ADDRESS:

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3. PHONE NUMBER:

PHONE NUMBER:

4. AUTOMOBILE COVERAGE

	YES	NO
Are all licensed drivers in the household listed on your policy?	*AUTOMOBILE COVERAGE Are all licensed drivers in the household listed on your policy? YES	Are all licensed drivers in the household listed on your policy? NO
Have you listed drivers on your policy that have regular use of your vehicle?	Have you listed drivers on your policy that have regular use of your vehicle? YES	Have you listed drivers on your policy that have regular use of your vehicle? NO
Do you use your vehicle for business use?	Do you use your vehicle for business use? YES	Do you use your vehicle for business use? NO
Do you have rental coverage in case of an accident and you need to rent a car?	Do you have rental coverage in case of an accident and you need to rent a car? YES	Do you have rental coverage in case of an accident and you need to rent a car? NO

Comments:

5. GOOD STUDENT DISCOUNTS

	YES	NO
High School and College Students may be eligible for a good student discount. Would you like further information?	*GOOD STUDENT DISCOUNTS High School and College Students may be eligible for a good student discount. Would you like further information? YES	High School and College Students may be eligible for a good student discount. Would you like further information? NO
Do you have a college student that has taken a vehicle to school?	Do you have a college student that has taken a vehicle to school? YES	Do you have a college student that has taken a vehicle to school? NO

What School?

6. ADDITIONAL DISCOUNT ELIGIBILITY

	YES	NO
Do you have an anti theft device installed in your vehicle?	*ADDITIONAL DISCOUNT ELIGIBILITY Do you have an anti theft device installed in your vehicle? YES	Do you have an anti theft device installed in your vehicle? NO

What type of device?

7. What is the estimated number of miles you drive in a year

What is the estimated number of miles you drive in a year

8. PERSONAL SECURITY

	YES	NO
Have you reviewed your liability limits?	*PERSONAL SECURITY Have you reviewed your liability limits? YES	Have you reviewed your liability limits? NO
Do you have enough coverage to protect your assets if you caused bodily injury or property damage to others in an accident?	Do you have enough coverage to protect your assets if you caused bodily injury or property damage to others in an accident? YES	Do you have enough coverage to protect your assets if you caused bodily injury or property damage to others in an accident? NO
Do you have a Personal Umbrella Policy?	Do you have a Personal Umbrella Policy? YES	Do you have a Personal Umbrella Policy? NO

Comments:

9. WOULD YOU LIKE A QUOTE ON POLICIES OUR AGENCY DOES NOT CURRENTLY WRITE?

WOULD YOU LIKE A QUOTE ON POLICIES OUR AGENCY DOES NOT CURRENTLY WRITE? Yes

Comments:

10. RETIREMENT/DISBILITY

	Yes	No
If you were hurt or unable to work, do you have adequate financial means to pay your household bills for an extended time period?	*RETIREMENT/DISBILITY If you were hurt or unable to work, do you have adequate financial means to pay your household bills for an extended time period? Yes	If you were hurt or unable to work, do you have adequate financial means to pay your household bills for an extended time period? No
If not, would you like to be contacted for a disability quote?	If not, would you like to be contacted for a disability quote? Yes	If not, would you like to be contacted for a disability quote? No
If you are about to retire, have you considered insurance for long term care?	If you are about to retire, have you considered insurance for long term care? Yes	If you are about to retire, have you considered insurance for long term care? No
Do you want to be contacted about a long term care quote?	Do you want to be contacted about a long term care quote? Yes	Do you want to be contacted about a long term care quote? No

Comments:

11. LIFE INSURANCE

	Yes	No
Do you have life insurance?	*LIFE INSURANCE Do you have life insurance? Yes	Do you have life insurance? No
If not, do you want to be contacted about a quote?	If not, do you want to be contacted about a quote? Yes	If not, do you want to be contacted about a quote? No

Comments:

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Thank you for taking our survey! Your account manager will will contact you within the next 48 hours.
We appreciate your business, and we look forward to servicing your accounts in the coming year. If you have immediate needs please call us at 800.658.7956. We are also available 24/7 at www.providerig.com

Did you know that Provider Insurance Group provides a host of commercial insurance products to protect your business?
These include but are not limited to: Property, Liability, Workers Compensation, Health Insurance and other Employee Benefits.

Contact us for a comprehensive review of all your business insurances.

PROVIDER INSURANCE: RENEWAL SURVEY FOR AUTO

1. Provider's Policy Renewal Survey - Auto

*1. YOUR NAME:

2. ENTER YOUR PREFERRED EMAIL ADDRESS:

*3. PHONE NUMBER:

4. AUTOMOBILE COVERAGE

5. GOOD STUDENT DISCOUNTS

6. ADDITIONAL DISCOUNT ELIGIBILITY

7. What is the estimated number of miles you drive in a year

8. PERSONAL SECURITY

9. WOULD YOU LIKE A QUOTE ON POLICIES OUR AGENCY DOES NOT CURRENTLY WRITE?

10. RETIREMENT/DISBILITY

11. LIFE INSURANCE

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1. YOUR NAME:

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3. PHONE NUMBER: