Referral Entry Form

ipSBS Customer Referral Rewards Program

Reduce Your Bill!
We are offering a $300.00 credit as a reward for each qualified referral we receive from our customers. Simply provide us with contact information for your referral and if the referral brings us a new client, we will issue the $300.00 credit to your account.

Referral Contact Information
Name:*	(The person we need to call)
Business Name:*
Business Address:*
Business Phone:*	(include area code)
E-mail:
Your Contact Information
Name:*
Business Name:*
Business Address:*
Business Phone:*	(include area code)
ipSBS Ext.:
E-mail:
	_* = Required Fields