Refer-A-Friend
Our gift to you for referring a friend to Bollinger … a $10 gas card!
Complete or give this form to a friend,
relative, or business associate.
If we provide them with a quote,
we will send YOU a $10 gas card
for each person you refer to us. *
It’s that simple! So why not refer someone today?
*Total payments not to exceed $25.
To participate in this Refer-A-Friend program you must be either a current Bollinger Personal Lines customer
or a fan of Bollinger’s Insurance Geek on facebook.
Thank you for your interest in Bollinger. We welcome the opportunity to provide you with a comparison insurance quote.
Complete the information below and return this form to us.
We look forward to hearing from you!
I am interested in the following insurance products (check all that apply):
□ Automobile □ Homeowners □ Renters □ Condominium/Co-op □ Flood □ Valuable Items
□ Personal Liability Umbrella □ Boat/Yacht □ Wedding □ Life Insurance
NAME AND ADDRESS: __________________________________________________________________________
TELEPHONE : _____________________________EMAIL: ______________________________________________
NAME AND ADDRESS OF PERSON WHO REFERRED YOU: __________________________________________________
___________________________________________________________________________________________
IS THE PERSON THAT REFERRED YOU A BOLLINGER CLIENT AND/OR FACEBOOK FAN?____________________________
Phone us at:
NORTHERN NJ: 800-526-1379, Ext. 4621
SOUTHERN NJ: 888-577-4998, Ext. 7412
WALL, NJ: 732-919-0200, Ext. 112
SPARTA, NJ: 800-253-1521, Ext 4205
NEW YORK: 800-962-5524, Ext. 7523
CONNECTICUT: 203-622-1188, Ext. 6640
PENNSYLVANIA: 215-351-4726
Email Referral Forms to referrals@bollingerinsurance.com
Fax Referral Forms to 973-921-2876, Attention: Janice Purcelly
www.BollingerInsurance.com