The Yes Network - Customer Referral Submission Form

Referrals

Remember, the more referrals you supply, the more rewards you will accumulate. For every referral that leads to a group presentation, you will receive a complimentary, recently recorded Seminar on DVD of your choice ($89.95 value) or an extra year of live seminars added onto your existing current or expired membership. In addition, when you complete and submit this form, you will gain immediate access to a powerful Wake Up and Be Alive audio for daily positive programming. Of course, the most important reason to refer us to people you care about is the huge positive impact that The Yes! Network will have on their lives. Thank you for helping...

	Your Name
	Your Email
	Your Phone Number
Please complete as much of the below information as possible. If you do not have any part of the information handy, we can either look it up ourselves, or call you. If you would prefer that we call you for referrals, rather than complete the remainder of this form...Please check this box:
Referral #1
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Referral #2
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Referral #3
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Referral #4
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Referral #5
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Referral #6
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Referral #7
	Contact Name
	Company or Organization
	Daytime Phone Number
	Email
Additional Comments

Check this box to have us contact you to discuss your referrals: