AGENCY REPORT CARD

Name of  Policyholder
E-mail address

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

1 - Our featured carrier is the Erie Insurance Group. Overall, how satisfied are you with the
      value of your Erie policy?
      
Very satisfied
     
Satisfied
     
Neutral / Unsure
     
My Policies are with another carrier thru Werle & Rushe Agency
     
Somewhat Dissatisfied
     
Completely Dissatisfied

2 - Our agency hours are 9:00 am - 5:00 pm MON, WED, THU, FRI;
      9:00 am - 6:00 pm TUE; 9:00 am - 12:00 pm SAT.
      Does this meet your needs?
      
Very satisfied
     
Satisfied
     
Neutral / Unsure
     
Somewhat Dissatisfied
     
Completely Dissatisfied

3a- LONG-TERM POLICYHOLDERS ONLY
       If you experienced a claim within the past 5 years, with any carrier represented by
       our agency, were you satisfied with your claim settlement experience?
      
Very satisfied
     
Satisfied
     
No Claim
     
Somewhat Dissatisfied
     
Completely Dissatisfied

3b - NEW POLICYHOLDERS ONLY
        Thank you for recently entrusting your insurance needs with our agency. We want
        to know if you were satisfied with your policy purchase experience. Did we explain
        the policy coverages?  Did we present you with options? Did we explain what to do
        in the future to pay premiums or report claims?
 
      Very satisfied
     
Satisfied
     
Neutral / Unsure 
     
Somewhat Dissatisfied
     
Completely Dissatisfied

4 - Insurance premiums can be paid in person; via personal check by mail; individual
      electronic funds transfer via the internet; and (some carriers) by credit or debit
      cards. Do these options meet your needs?
      
Very satisfied
     
Satisfied
     
Neutral / Unsure
     
Somewhat Dissatisfied
     
Completely Dissatisfied

5 - Please rate your overall satisfaction with our agency.
       
Very satisfied, would recommend to others
     
Satisfied Overall, but not to the level of recommendation
     
Neutral / Unsure
     
Somewhat Dissatisfied
     
Completely Dissatisfied

Please add your personal comments -