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Referral Form

Refer a friend to Frederick Agency, Inc.

Refer A Friend

You can win $500 just for talking about us! We know that the best advertising we can get is YOU talking to your friends and family about your great experience with our agency. Which is why we are excited to introduce our Referral Program, our way of thanking you just for talking about us! How it works… You will receive $5.00 for each referral you send us. Your name will also be entered each time you send us a referral to win $500 in a drawing held on the Monday before Thanksgiving…just in time for your holiday shopping! Program Rules:

  • Anyone can participate, you do not need to be a client of ours to send us a referral.
  • In order for the referral to count the referred must mention your name either on a form or over the phone the first time they get in contact with us.
  • The referral must be inquiring. The individual does not need to be from Ohio but whatever is being covered must be located in the state.
  • The prospects referred do not have to become our clients, but they must be quoted for a policy.
  • We are not responsible if the law says you cannot win due to age or any other restrictions.
  • The $500 drawing will take place on the Monday before Thanksgiving each year.

Your Information
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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
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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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