Name

First and Last Name of the person you are referring to us

First Name

Last Name

Provide the email address for the person you are referring to us

Phone

Phone Number for the person you are referring to us

(###)

###

####

State

State where the the person you are referring to us lives (must be one of the choices below)

Your Name (so we know who to send the $100 to)

Must be a Current Customer with an active policy with one of Sawyer Health Solutions affiliated insurance companies

First Name

Last Name

Your Policy Number

Found on your Insurance Card

WE REWARD YOU FOR YOUR REFERRALS

You can receive $100 for every new customer you refer to us!*

Plan Options are Available in the Following States:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin

* Limitations Apply. The person providing the referral must be a current customer with an active policy with one of Sawyer Health Solutions affiliated insurance companies. The referred customer must purchase a participating plan and it must remain in effect for at least 60 days. Referral must be submitted no later than 90 days after the issuance of the new referred customers participating plan.

** By submitting your information you agree that we may contact you and the person you are referring at the above-listed email or phone number as protected within our Privacy Policy. You also agree that you will only be awarded the $100 referral fee if the conditions listed above have been met.