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Referral Form

Refer a friend to Heritage Insurance LTD

Join our Client Referral Program!

	Win a Big Screen Smart TV or an iPad! Refer Someone Now!

For each friend, family member, associate or client you send to Heritage Insurance Ltd for a quote on their auto, home, commercial or farm insurance needs, we will automatically enter your name into our Client Referral Contest. You will have a chance to WIN a Big Screen TV or an iPad (…your choice) in our monthly draw AND a $5 Gift Card to Tim Hortons.

Ask your Friends to call our office and mention your name to receive their
FREE, NO HASSLE, NO-OBLIGATION, GREAT RATES comparison quote.

For each referral, you will receive a $5 Gift Card to Tim Hortons.

No matter how busy we are at Heritage, we ALWAYS reserve time to accommodate NEW clients referred to us. And we know that you put a little of yourself “on the line” whenever you recommend us to a friend, family member, associate or client, and we take that responsibility very seriously.

Our entire Team will do everything possible to earn your trust and confidence in our brokerage.

Thanking you in advance for taking the time to review the qualifications to become one of our Referral Club Members.

Your Information

First Name*

Last Name*

Your Email Address*

Your Phone Number*

Your Friend's Information

Friend's First Name*

Friend's Last Name*

Your Friend's Email Address*

Your Friend's Phone Number*

Special Comments*

Submission Validation