Name of  Policyholder
E-mail address

Thank you for taking the time to complete this brief claim service report card. We want to meet or exceed
your expectations. Sometimes we simply need to ask if we are succeeding.

1 - Your recent claim required notification of our agency and/or the carrier.
Were you satisfied with the reporting process?
       Very satisfied
      Satisfied
      Neutral / Unsure
      Somewhat Dissatisfied
      Completely Dissatisfied

2 - The Claim Department is expected to call you to confirm your loss report and explain the claim handling process. Were you satisfied with this part of the claim process?
       Very satisfied
      Satisfied
      Neutral / Unsure
      Somewhat Dissatisfied
      Completely Dissatisfied

3 - Overall, were you satisfied with your claim settlement experience?
       Very satisfied
      Satisfied
      No Claim
      Somewhat Dissatisfied
      Completely Dissatisfied

Please add your personal comments -