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* 1. Name

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* 2. Phone Number

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* 3. Age

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* 4. What is your ethnic background?

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* 5. With whom do you have your auto insurance?

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* 6. When was the last time you shopped for auto insurance

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* 7. Which of the following statements best describes how you shopped for auto insurance most recently?

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* 8. How many drivers are in your household?

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* 9. How many cars are in your household?

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* 10. Which of the following devices are you most comfortable using?

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* 11. Have you had any major driving violations in the last 5 years (reckless driving, DUI, etc)?

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* 12. Have you had more than 3 speeding tickets in the last 2 years?

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* 13. Is your driver's license currently suspended or revoked?

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