list the companies you have cooperated with

Agency appointment?      Yes      No

If not, please explain

How would you rate their performance? Excellent Good Fair Poor *

Do you receive any discount?      Yes      After requested      Not at all

If yes, of what level? 5-10% 10-15% 20-25% Over 25%

Are final D/As in order?      Yes      No

Do you receive prompt replies to your inquiries?      Yes      No

Have you experienced any problem through your cooperation with companies listed in Agents One? Please describe

Was your problem finaly solved?      Yes      No

Through your contact with represented companies, do you mention the Agents One name?      Yes      No

What do you expect from your agent's service? (List with priority)

Are you contracted with any agent?      Yes      No

If yes, in what areas?

Agents One representatives

Do you have any objection in being visited by Agents One representatives?
Only when time permits      Yes, but not frequently      Do not see any reasons for these visits

Do you feel visits from representatives are beneficial?      Yes      No

Do you often receive circular messages from our office regarding various information from our members?
Yes      No      No, but I would

Thanking you in advance for your cooperation