Referral Form

Refer a friend to Kaplan Insurance Agency

FREE GAS for your car!!!!

THANK YOU so much for your generous referral! Nothing feels better than a referral because it shows us you like and trust us.

We understand that making a referral is a very personal thing and in a little way a reflection on you.

We promise to work extremely hard to ensure all our referrals our provided an excellent and timely service experience. We will do everything we can to ensure they are well taken care of and happy.

As a way of thanking you, we are currently running a referral reward program. It’s pretty simple and works as follows:

You provide us with a qualified referral.
They go through the quote process with us.
We send you a $20 gas card.

No strings attached. Your reward is not dependant on the referral doing business with us. Of course, we hope they choose us and make the move to Kaplan Insurance. But in the unlikely event they stay with their current provider, you still receive your gas card.

A qualified referral is defined as a homeowner that fills out our complete application and also provides us with a copy of their current policy declarations page.

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*

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