Refer

For a limited time only, you earn $25 for every valid* referral you submit. There’s no limit on the number of valid referrals you can submit. For each referral who purchases an EZ-CARE system, we’ll send you either a Visa Card or credit your account, whichever you choose.

There’s no limit on the number of referral awards you can receive.

*EZ-CARE reserves the right to reject any referrals it determines are invalid

Your Contact Information

Your Name*

Organization*

Client ID (If Applicable)

Country*

State*

Phone*

Email*

Full Street Address*

City*

Zip/Postal Code*

If my referral purchases a system, please (choose one):

Credit our SofterWare
account $200

Send me a
$100 Visa Card

Your Referral’s Contact Information

(Please fill out as much as possible)

First Name:*

Last Name:*

Organization:*

Country:*

State:*

Phone:*

Email:*

Number of Children:*

Please tell us as much as possible about their needs and situation:

*Required