Referral Program

C. Don Filer Agency

Refer your friends and family to our office and we will send you a $5 Starbucks gift card and will also donate $10 to our designated charity. For June and July we are donating to American Parkinson Disease Association an organization whose mission is to provide the support, education, and research that will help everyone impacted by Parkinson’s disease live life to the fullest.

Whether they purchase a policy from us or not, your referral counts . Just be sure they mention your name when they call and why you referred them.

The highest compliment we can receive is your recommendation of our services to friends and family. Thank you for all the referrals you've trusted us with over the years.

Your Information

First & Last Name ✶

Email ✶

Phone ✶

Referral Information

First & Last Name ✶

Relationship to You ✶

Email ✶

Phone ✶

Street Address

City

State

ZIP Code

Anything Else?

Comments

Binding Agreement

I understand that coverages cannot be bound, cancelled or amended via this form, fax, email or voice mail without written or verbal communication from C. Don Filer Agency, Inc. ✶

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