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: *

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© 2018 Cohen Miles Insurance Agency, Inc.

375 Concord Avenue Suite 005
Belmont, MA 02478