CAREERS | FAQ | Coronavirus Response Submit A Referral Referral Rewards Referrer Information The referrer is the person making the referral Referrer First Name * First name of the person making the referral Referrer Last Name * Last name of the person making the referral Referrer Email * Email address of the person making the referral to send updates about reward progress. A VALID EMAIL ADDRESS IS REQUIRED TO SUBMIT THIS FORM OR IT WILL BE REJECTED AS SPAM. Referrer Phone Number * Phone number of the person making the referral in case we have questions about your referral or your reward Referrer Mailing Address * Referrer Mailing Address Referrer Mailing Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal This is the address where the referral reward will be sent Is the Referrer a Premier customer? * Yes No Referral Information The referral is the person being referred to Premier Referral First Name * First name of the person being referred to Premier Referral Last Name * Last name of the person being referred to Premier Referral Email * Email address of the person being referred to Premier Referral Phone Number * Phone number of the person being referred to Premier. We need this so we can contact them to make an appointment with them to inspect their roof. Referral Address * Referral Address Referral Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal The address of the property being referred Premier Branch Closest to Referral Address * Colorado Springs Denver Des Moines Fort Collins Kansas City Minneapolis Oklahoma City Omaha Raleigh San Antonio St. Louis Topeka Wichita Additional Project Information Any details or specific information you can share about the project you are referring are welcome Premier Representative If you have a specific representative at Premier you wish to receive this referral, please put their name here. Otherwise, your referral will be assigned to a Premier Representative who is working in your referral's neighborhood. Full Name of Person Filling Out This Form (If Not Referrer) Put your first and last name here if you are filling out this form on behalf of the referrer Program Details * I have read the Program Details and understand how the Premier Referral Rewards Program works I am submitting this form on behalf of the referrer and acknowledge that if they do not understand the process I will be responsible Read Program Details Submit Copyright © 2005-2020 Premier Roofing LLC All Rights Reserved Privacy Policy We Value Your Privacy SETTINGS NextRoll, Inc. ("NextRoll") and our advertising partners use cookies and similar technologies on this site and use personal data (e.g., your IP address). If you consent, the cookies, device identifiers, or other information can be stored or accessed on your device for the purposes described below. You can click "Allow All" or "Decline All" or click Settings above to customize your consent. NextRoll and our advertising partners process personal data to: ● Store and/or access information on a device; ● Create a personalized content profile; ● Select personalised content; ● Personalized ads, ad measurement and audience insights; ● Product development. For some of the purposes above, our advertising partners: ● Use precise geolocation data. Some of our partners rely on their legitimate business interests to process personal data. View our advertising partners if you wish to provide or deny consent for specific partners, review the purposes each partner believes they have a legitimate interest for, and object to such processing. If you select Decline All, you will still be able to view content on this site and you will still receive advertising, but the advertising will not be tailored for you. You may change your setting whenever you see the on this site. DECLINE ALL ALLOW ALL