Contact
Information
Name:
Address:
City/State/Zip:
Phone:
Email:
Questionnaire
Would you be interested in buying Savings Bank Life
Insurance if you could get a 12% discount on your automobile insurance?
Please Select
Yes
No
Do you own any recreational vehicles? (RV, JetSkis,
mopeds, snowmobiles)
Please Select
Yes
No
Do you own a boat?
Please Select
Yes
No
Does your town have requirements that
if a certain percentage of your structure is destroyed, the structure
must be removed? Do you have coverage for this?
Have you been concerned about flooding in your area?
Please Select
Yes
No
Are you concerned about water or sewage backing up
through your pipes or toilets?
Please Select
Yes
No
Have you ever been concerned about earthquake damage?
Please Select
Yes
No
What are the ages of your children?
Are you currently or have you ever been an employee
of the city of Marlborough or had a relative that was?
Please Select
Yes
No
Have you made upgrades to your condominium or home?
Please Select
Yes
No
Do you have an office at home?
Please Select
Yes
No
Do you have valuable home computers or other stereo,
CD or electronic equipment at home?
Do you own any vacant property?
Please Select
Yes
No
Do you have anything of value that C. E. Conary needs
to know about in order to provide you with proper coverage?
Do you have replacement costs insurance on your property?
Please Select
Yes
No
Do you have property of unusual value such as jewelry,
furs, guns, silverware, antiques or cars?
Do you ever see a need to rent a vehicle?
Please Select
Yes
No
Do you know whether you need to purchase additional
insurance from the rental agency when renting a vehicle?
Do your children have a vehicle or use of a vehicle
at college?
Please Select
Yes
No
Are you adequately insured if your vehicle needs to
be towed?
Please Select
Yes
No
Do you require home remodel or construction contractors
to have workers compensation and liability coverage?
Please Select
Yes
No
Do you employ domestic help, childcare or other home
workers?
Please Select
Yes
No
Do you travel overseas?
Please Select
Yes
No
Do you own a condominium?
Please Select
Yes
No
Do you own a second home?
Please Select
Yes
No
Are you concerned that your life insurance coverage
might not be adequate to meet your family's needs?
Do you have adequate health, dental, prescription
and disability insurance?
Do you believe you need insurance coverage for an
at-fault accident totaling over a million dollars?
Do you have a clear understanding of your insurance
policies?
Are there additional services you wish your agent
would provide for you?
Do you feel you are paying too much for any of the
insurance coverages at right? If yes, please place a check next
to the type of coverage.
Do you know how to handle a claim if you have one?
Comments:
Thank
you for completing our questionnaire. This will help us serve you
better. Please click the "Submit" button below to send
us your information.
The
following questionnaire is designed to enable our staff to provide
our existing and new customers with the information you are most interested
in obtaining. The information will ensure you are getting insurance
coverages designed to meet your individual needs. As always, we are
dedicated to providing you with prompt, professional service and competitive
pricing. The informational questionnaire is just another step in our
goal of developing a personal relationship with our customers.