Policy Number:

Name:

Address:

Phone:

Email:

Phone calls to our company are answered promptly:

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree

Customer Service Representatives handle my requests promptly and courteously:

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree

The Customer Service Representative was knowledgable and able to answer questions about my certificate:

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree

I am satisfied with the service from my Agent:

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree

I am satisfied with my Fraternal Benefits:

Strongly Agree
Agree
No Opinion
Disagree
Strongly Disagree

Comments and Suggestions: