Submit a Referral

If you referred a contractor to the RCPA Fuel Card and they signed up, you will receive a credit to your rebate. Simply fill out your information as the referrer and who you are referring.

Name of Referrer

First Name

Last Name

Entity/Organization of Referrer

Email of Referrer

Phone Number of Referrer

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I am Referring

First Name

Last Name

Entity/Organization of Your Referral

Phone Number of Your Referral

(###)

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Email of Your Referral