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  5. Apple TV
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Questions marked with a * are required Exit Survey
 
 
* Insurance is boring (But we all need it)... Giving away awesome prizes and having Great Agents isn't! Please take the following survey for a chance to win (1) Apple TV. The drawing will be held January 27, 2017. MUST BE 18 YEARS OR OLDER TO ENTER. Please check the box that you agree to the Terms and conditions (click here to read) of this sweepstakes.  
 
I agree
 
 
 
* What is your date of birth?
MonthDayYear
  
 
 
 
* The Denver Broncos are the greatest Football Franchise EVER! Answering false disqualifies you...  seriously dont answer false.
 
True
 
False
 
 
 
* How satisfied are you with your current auto insurance?
 
Completely Satisfied
 
Somewhat Satisfied
 
Neither Satisfied or Dissatisfied
 
Somewhat Dissatisfied
 
Completely Dissatisfied
 
 
 
* Who is your current Auto/Home/Renters Insurer?
 
 
 
* What best describes your life insurance?
 
I don't have life insurance but I need it
 
I have life insurance through work
 
I have life insurance, but I likely need more
 
I have life insurance but my spouse/partner does not
 
I'm bulletproof and don't need any life insurance.
 
 
 
* Do you own or rent?
 
Own a home
 
Own a condo
 
Rent a home
 
Rent an apartment
 
Van down by the river
 
 
 
* When do you plan to purchase your next home?
 
Currently looking
 
1-3 months
 
4-6 months
 
7-12 months
 
More than a year
 
I am never moving ever again!
 
 
 
* How many vehicles are in your household?
 
1
 
2
 
3
 
4
 
5+
 
 
 
* First and Last Name (this is how we contact and announce the winner)
   
* Zip
   
* Cell
   
* Email