Referral Form

Refer a friend to 12 Times Better Insurance Plus

For every referral we receive we will send you a $5.00 Amazon gift card. It also enters you into our monthly $100.00 Amazon gift card drawings.
Plus we will donate $5 to the 12 Times Better High School Student Athlete and Percussionist in need Fund!

💙 The person you refer does not have to purchase a policy. Our referral program

is open to anyone whether they are a client or not. 💚

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*

Submission Validation

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12 Times Better Insurance Plus

3108 A Street SE, Suite A, Auburn, WA 98002 | 425-432-4999 | 253-249-7581