This or That Survey

We will be selecting a few random surveys to win a $25 gift card. Complete your submission for a chance to win!

Step 1 of 12

Name*
First Last
Email*

Coffee or Tea?*
Coffee
Tea

Dog or Cat?
Dog
Cat

Pizza or Tacos?*
Pizza
Tacos

Netflix or YouTube?*
Netflix
YouTube

iPhone or Android?*
iPhone
Android

In Person Shopping or Amazon?*
In Person
Amazon

Target or Walmart?*
Target
Walmart

TV / Movie or a Book?*
TV / Movie
Book

Sweet or Salty?*
Sweet
Salty

Michigan State or Michigan?*
Go Green!
Go Blue!

Thank you for helping us get to know a little more about YOU!
Please select your favorite options below for a chance to win a $25 Gift card
Amazon
Target
Starbucks
Subway
Home Depot

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Michigan Insurance and Financial Services - Grand Blanc

8469 S Saginaw St
Grand Blanc, MI 48439

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(810) 396-9950

dave@miafs.com

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Michigan Insurance Quote

Step 1 of 10

Name*
First Last

Date of birth*
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DD
YYYY

Spouse name
First Last

Spouses date of birth
MM
DD
YYYY

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Name(s) and date of births of any other resident drivers

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Year Make Model

Notes if any
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