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Referral Form

Refer a friend to Waterford Insurance Agency

The loyalty our community has shown us is amazing, and our best advertising is the positive response we get from our clients.

We would like to reward those who take the time to recommend Waterford Insurance Agency to their friends and family. Are you happy with our service? Do you know someone who could use our services?

Our Referral Program is a great way to help out someone you know and love while earning a chance to win a Kindle Fire.



Every time you send us a referral, we will mail you a Gift Card and enter your name into a drawing. Once we have received 50 referred names, we will draw a winner who will be invited to our office for a photo opportunity while receiving their Kindle Fire! 


Your Information
First Name
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Last Name
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Your E-Mail Address
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Your Phone Number
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Your Friend's Information
Friend's First Name
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Friend's Last Name
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Your Friend's E-Mail Address
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Your Friend's Phone Number
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Special Comments
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Submission Validation
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