Sample insurance company questionaire:
1. Are you a law-abiding citizen? (Y/N)
If you answered "Yes", then please skip to the bottom and sign the "preferred customer rate" signature block. A one time payment will be remitted in full for lifetime coverage upon completion and submission of this form because multiple payments for any smaller incremental periods will not be worth the price of postage for such small payments. All payments will be accepted in Monopoly cash only.
2. Are you a criminal? (Y/N)
If you answered "No", then please return to Question 1.
3. What criminal activities do you participate in?
A. Rape
B. Murder
C. Burglary
D. Mugging
E. Arson
F. Assault
G. Other (Describe)
4. In the space provided, please list all pistols currently owned by make, model, caliber, serial number.
5. In the space provided, please list all rifles currently owned by make, model, caliber, serial number.
6. In the space provided, please list all shotguns currently owned by make, model, gauge, serial number.
7. In the space provided, please list all other firearms/weapons currently owned by make, model number, caliber, and serial number where applicable.
8. In the space provided, please list all arrests and convictions for any criminal activities you have participated in.
9. Do you use any illegal drugs or abuse any prescription medication? (Y/N)
If so, please list the drugs/medication and your suppliers.