Zero Deductible Auto Glass Survey * 1. Do you currently have safety glass coverage (e.g., windshield) on your auto insurance policy? No Yes Uncertain * 2. Have you ever used it? No Yes Uncertain * 3. Did you pay a deductible for your last auto glass replacement? No Yes Uncertain * 4. Are you happy you have auto glass coverage on your policy? No Yes Indifferent * 5. Were you aware that Arizona law currently requires that you have an option to purchase zero deductible auto glass coverage as part of your comprehensive auto insurance policy? No Yes * 6. Would you be upset if you could no longer purchase the zero deductible protection? No Yes Indifferent * 7. Are you aware there is a state senate bill to take that option away from you? No Yes * 8. How important to you is the option to choose a zero deductible auto glass policy? Extremely Important Very Important Moderately Important Slightly Important Not at all Important Please let us know why the zero deductible option is or isn't important to you. Please feel free to share your story. * 9. Would you like to be kept up to date on the status of this bill? No Yes * 10. Would you be willing to let your state senator know your feelings about this subject? No Yes * 11. Please fill out the information below and we will keep you informed about the status of the bill that will eliminate your guaranteed option to purchase zero deductible auto glass coverage. Your address will only be used to verify your state senator and representatives. Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Done