Referral Form

Refer a friend to Magnolia Insurance

We love referrals! The greatest testament that our customers can provide is by referring their friends and family to Magnolia Insurance. Thank you for your referral, and we thank you even more for your continued business.

Your Information

First Name*

Last Name*

Your Email Address*

Your Phone Number*

Your Friend's Information

Friend's First Name*

Friend's Last Name*

Your Friend's Email Address*

Your Friend's Phone Number*

Special Comments*

Submission Validation

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Quick Links: Home Contact	Palm Springs Office 1000 N. Farrell Dr. #102 Palm Springs, CA 92262 (760) 318-8446	Coachella Office 49975 Harrison Ste. E Coachella, CA 92236 (760) 391-5432	Hemet Office 1220 S State St Hemet CA 92543 (951) 392-8268
CA License #: 0D34063