Goose Insurance Marketing Referral Program Application

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We're excited to welcome you into our affiliate community! Your interest in joining our flock means a lot to us. To take the next step, please take a moment to review the referral marketing fee breakdown and complete the form below. Once we receive your information, our team will promptly review it and get back to you as soon as possible. Thank you for considering partnership with us, and we look forward to the opportunity to collaborate with you!

Breakdown of referral reward*:

Term Life Insurance Policy - $150
Super Visa Insurance Policy - $150
Visitors to Canada Insurance Policy - $100
Multi-Trip Travel Medical Insurance Policy - $100
Single-Trip Travel Medical Insurance Policy - $50

* Referral reward is dependant on the first policy purchased by each new member referral. Goose Insurance reserves the right to modify referral compensation at its sole discretion at any time.

Full Name
*

Address (Home Address, City, Province, Postal Code)
*

Phone Number:
*

E-mail Address: *

Occupation *

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