Type

Full Name*

Address*

Phone Number

Cell Number*

Email*

Age*

Company Name*

Company Phone*

Products*

Friendliness and knowledge
of Staff

Timely and comprehensive
response from Staff

Efficiency and promptness
in claim processing

Quality of products in terms
of features and pricing

Availibility of information
on website

Miscellaneous (Any other
comments you want to make?)

Would you recommend the
company’s products / services
to others?