Customer reference form

Just a few clicks away from your reward!

Please fill in the following form to make your reference.

The reward program process is as follows:

  • You fill in the form below and we suggest that you notify the person you referred to us;
  • One of our advisors will contact the person you have identified;
  • Your loved one quotes with Assur360;
  • We will contact you to confirm that the process has been completed and make arrangements to deliver your gift card.