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Referral Program Form Template

Boost Your Referrals with Our Easy-to-Use Template

Struggling to generate quality referrals? This referral program form template is designed to help businesses like yours capture valuable leads and incentivize your customers to promote your services. With easy fields for clients' names, emails, and referral details, you'll simplify data collection while motivating your existing customers to share their positive experiences. Utilize this powerful tool to enhance customer engagement, track referral success, and build a loyal community around your brand-try out the live template and see the results for yourself!

Use this Template (FREE) Live Preview
Your full name
Your email address
Are you an existing customer?
Yes
No
Would you like to receive updates about your referral?
Yes
No
Referral full name
Referral email address
Referral phone number
What is your relationship to the person you are referring?
Friend or family
Colleague
Client
Business partner
Acquaintance
Prefer not to say
Other
Please Specify:
Do you have their permission to share their details with us?
Yes
No
Notes or context to help our team follow up
What are they interested in?
New purchase
Service consultation
Product demo
Partnership or enterprise inquiry
Support or training
Not sure
If eligible, what is your preferred reward?
Account credit
Gift card
Donation to a charity of my choice
Company swag
No preference
Prefer not to say
I have read and agree to the Referral Program Terms
Yes
No
I confirm I am at least 18 years old or meet the minimum age to participate
Yes
No
Please type your full name as your signature
Signature date
How did you hear about this referral program?
Company website
Email newsletter
Social media
Friend or colleague
In-store or on-site
Event or webinar
Online search
Prefer not to say
Other
Please Specify:
{"name":"Your full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Your full name, Your email address, Are you an existing customer?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting a referral program form template for FormCreatorAI article.

When to use this form

Use this template when you want a simple, trackable way to collect and reward customer or partner referrals. It fits SaaS trials, agencies passing leads, and stores offering loyalty rewards. Marketing teams get cleaner data; sales gets warmer leads; you gain a repeatable pipeline. Ask for referrer details, the prospect's info, and reward preferences in one place. If you need a one-off handoff instead of a rewards program, try the Referral form. For community services or care providers, a program may not suit; a Social services referral form might be the better path.

Must Ask Referral Program Questions

  1. Who is making the referral? (full name and email)

    This identifies the account to credit and gives you a clear contact for updates. It also prevents duplicate profiles and speeds up reward payouts.

  2. Who are you referring? (name, company, and work email)

    These fields help you verify the lead, match it in your CRM, and start outreach fast. Work email reduces spam and improves qualification.

  3. Why is this a good fit? (needs, timeline, and budget range)

    Short qualifiers boost lead scoring and help sales prioritize. You save time by focusing on referrals with purchase intent and authority.

  4. How should we deliver your reward? (method and country)

    Collecting the payout method and location lets you handle taxes, currency, and digital gift card options without back-and-forth. It also sets clear expectations for timing.

  5. Has the referred person agreed to be contacted?

    Consent protects you from compliance issues and improves response rates. If they prefer to reach out directly, share the Self referral form as an alternative.

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