Customer Referral

Question Title

* 1. Please provide YOUR contact information. The company you enter here will receive the 25% discount should the referral become a Brightline customer.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Please provide as much information as you can on the company you are referring.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 3. Do you mind if we tell the referral that you referred us?

Yes

No

Question Title

* 4. Thanks for the referral. We will provide feedback to the name and address you provided from time to time. Also feel free to contact us if you have any questions.