Referral Form

Refer a friend to Stahlka Agency

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

Your Information
First Name
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Last Name
Required
Your E-Mail Address
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Your Phone Number
Required
Your Friend's Information
Friend's First Name
Required
Friend's Last Name
Required
Your Friend's E-Mail Address
Required
Your Friend's Phone Number
Required
Special Comments
Optional
Submission Validation
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Our office phones are working intermittently, we are working to resolve the issue
in the meantime please use the following cell phone numbers

Fraser - Commercial Lines 716-510-8628
Jenn - Personal Lines 716-861-1328
Brad - Employee Benefits 716-465-7071

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