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* 1. Please indicate what this feedback relates to.

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* 2. Please indicate what type of insurance this relates to.

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* 3. On a scale of 1-7 how easy is it to do business with Pekin Insurance?

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* 4. Tell us a bit more why you chose that score. Please be as detailed as possible.

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* 5. Would you like someone to follow-up with you?

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* 6. Would you be interested in joining our research panel to help us improve your experience with Pekin Insurance?

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* 7. Your contact information if you'd like us to follow up with you or if you would like to join our research panel:

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