Referral Form

Refer a friend to The Miller Insurance Agency

Your referrals mean the world to us!

We work hard to earn each referral with great service every day.  You've supported us with referrals for over 15 years, and we've found a new way to say, "Thanks!"   As our way of saying thank you, we’re kicking off our new “Help Our Community” referral program.  We love supporting the charitable efforts in our community, so we’ve tied referrals and charitable giving together.  Here’s how it works:

• Give our contact information to a friend, family member or acquaintance to contact us and make sure they tell us that you were the one who referred them.  We will always ask as well.
• We will do a policy review and quote any of their insurance needs.
• The person you refer doesn’t have to purchase a policy from us if we’re not able to help them for your referral to count.
• For every referral we receive we will donate $10 to the charity selected for that quarter.
• During that quarter we will track the total funds donated from every referral.
• Once that quarter is over we will donate the totals funds to the charity and announce to total donated on our Facebook page.
Some charities we have contributed time or funds to in the past are: MS Lockup for a Cure, National Fallen Firefighters Foundation, Washington State University’s Risk Management and Insurance, Walk to Defeat ALS, and iCan Bike.

What qualifies as a referral you ask?......  A referral is when we get a call for a quote from someone saying you referred them to us.  

Our referral program is open to anyone, whether they’re a client or not.

That’s it!  It’s just that simple.  Help us help them!


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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