Referral Form

Refer a friend to CLH Insurance

We love referrals! The greatest testament that our customers can provide is by referring their friends and family to CLH Insurance. Thank you for your referral and we thank you even more for your continued business.  As a "Thank You", you'll receive a $5 Starbucks gift card and a donation to the area Food Pantry.   See our new Referral Program below. 

The CLH Insurance Agency “Help our Community”

Referral Program

Your referrals mean the world to us.  We work hard to earn each referral with great service and appreciation for your business every day.  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:

Each time we receive a referral from you, your name is entered into our annual referral drawing. 

What qualifies as a referral?

A referral is when we get a call for a quote from someone saying you referred them to us. Don’t worry we always ask if they were referred. 

·For every referral we receive, we will send you a $5 Starbucks card as our thanks and we will donate a matching  $5  to Circle of Concern Food Bank in St. Louis. 

·We will hold a yearly drawing from all the names of people that referred someone to us.

à This year’s drawing prize is $50 and an additional gift of $100 is given to the Brotherhood Mutual Mission, “CoMission Serbia Program.

àEach referral equals one entry into our yearly drawing.

àWe will announce who won in our Christmas  letter. If you will send us your picture, we will add this to the article. 

·That’s it. The person you refer does not have to purchase a policy or obtain a quote from us, if we’re not competitive, for your referral to count.  


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

Your Information
First Name
Last Name
Your E-Mail Address
Your Phone Number
Your Friend's Information
Friend's First Name
Friend's Last Name
Your Friend's E-Mail Address
Your Friend's Phone Number
Special Comments
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