Canadian Term Insurance

Complete our needs analysis form
Referral Program

Name *

Email *

Telephone *

(555) 123-4567

Birth Date

Gender

Male Female

Have you ever smoked? Yes No

Province

Amount of Insurance

Product Type

Health Risk

* Indicates required field
* The quoting process is only a quote and subject to further medical and underwriting requirements

Referral Program

For every unique referral you make to Canadian Tern Insurance you will automatically be entered into a monthly draw. For program details click here.

Send an Email to a friend and automatically be entered into a draw to win a prize.
Example of Email that will be sent to each referred person.

Dear [First Name] [Last Name],

I have referred you to Canadian Term Insurance as an individual who may be interested in their products and services. For more information on the company visit their website at www.canadianterm.com, or call (519) 473-4549 or toll free 1-866-943-4549 to speak to a customer service representative.

Sincerely,

[Your First Name][Your Last Name]

Personal Information:

Friend's Last Name:	*
Friend's First Name:	*
Friend's Email Address:	*
Your First Name:	*
Your Last Name:	*
Your Email Address:	*
Friend’s Age Range:	*
Friend’s Marital Status:	*
Friend’s # of Children:	*

* Indicates required field