Savings Survey Sterling & Sterling, Inc. provides affordable insurance products to your Family Fun Center. Please complete the following savings survey so we can better understand your needs. When you are finished, please click the "Submit" button and your survey will be sent to our Program Manager. Name of Fun Center Contact Name: How did you find out about our program? Please select... Web search (Google, Yahoo!, Bing!) Email from Sterling & Sterling, Inc. IALEI Publication Referral from existing client Other Phone#: Company Website Email * Street Address Address continued City State Please select... Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Zip Tell us about your center Type of operation (Check all that apply) ArcadeMini-GolfBatting CageBowlingGo-Karts InflatablesParty RoomsDriving RangeLaser TagSoftplay Bumper Cars/BoatsKiddie RidesCoin-Op RidesFoodOther Number of employees 0-55-1010-2525-50Over 50 Number of Years in Business Less than 1 year1-3 years3-5 yearsOver 5 years Optional: Approximate Total Receipts $0-$50,000$50,000-$100,000$100,000-$250,000$250,000-$500,000Over $500,000 Potential Savings What are you currently paying for your insurance coverage?$ Do not use commas or decimal points Your potential savings from using our Insurance Program:$ Would you like a representative to contact you regarding these savings? YesNo Contact Preferences How would you like us to contact you? PhoneMailEmail Should we use a different phone number than what was previously listed? YesNo - Use previous Phone #: ( ) - Should we use a different email address than what was previously listed? YesNo - Use previous Email address: Should we use a different mailing address than what was previously listed? YesNo - Use previous Address Street Address Address continued City State Please select... Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau Zip Captcha Please enter the characters you see in this picture: Characters This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.Can't see the image? Click here for an audible version in English. Need assistance with this form?
