Client Referral Forms, South Africa

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Client Referral Form

At CaraSure we are very proud of our heritage, being passionate, committed and service driven. It was therefore necessary to create this Referral system and acknowledge and provide incentives to those who always refer their friends and family to us.

Please provide us with your details and the person you wish us to contact and making them part of the CaraSure Family.

MY DETAILS
(Referrer)

First name*

Surname*

eMail*

Cellular

CaraSure Policy number

Not a CaraSure Policy holder

MY FRIEND/FAMILY MEMBER
DETAILS (Referral)

First name*

Surname*

eMail*

Cellular

Caravan

Off-Road Caravan

Camper Trailer

Motorhome

Make*

Model*

Year*

Your relationship

Friend

Family member

DECLARATION

I hereby declare that all the information provided above is true and correct. I also confirm the person I referred to CaraSure is familiar with my intentions that a consultant from CaraSure will be contacting them.

I further understand that CaraSure will ONLY use this name for the purposes of CaraSure’s business and that this name will not be forwarded to other person and/or institution/company.

Client Referral