Refer a Friend from Cohen Miles Insurance Agency

Reliable insurance for you and your family

Refer a friend to Cohen Miles Insurance Agency and be entered in our monthly drawing for a gift card to a local business. Every referral you send over will enter your name in the monthly drawing.

Referrer information

Your name *

Your e-mail address *

Friend information

Friend's name *

Address

E-mail

Phone

Best contact method

• E-mail
• Phone

Relationship to you

Insurance needs

• Auto
• Boat
• Business
• Home
• Life
• Motorcycle
• Umbrella

Binding Agreement

I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.

Required fields are marked with: *

Submit

We respect your privacy. Your information will be sent securely and handled with care.
View our privacy policy.

Note: leave the Subject field blank if you are a real person. If this field is filled in, your request will be ignored. This helps us protect against automated form posts (spam).
Subject

Home  |  About  |  Contact  |  Service  |  Privacy  |  Disclaimer  |  Search

© 2023 Cohen Miles Insurance Agency, Inc.

105 Chestnut Street Ste 31
Needham, MA, 02492