Use this when

A customer, partner, or employee is sending you a warm lead.

Then

Follow up with the prospect and log the outcome.

Review before sharing

Check names, dates, totals, and scope. Use a secure system for sensitive details that do not belong in a simple form.

Entries are processed in this browser. We do not receive them unless you save them to a Pro account.

Live document preview1.0.0

Your business

Referral Form

1.0.0

Your completed fields will appear here. Load the example to see a finished document.

Agent-readable document text

REFERRAL FORM
Document version 1.0.0


Created with FreeBusinessForms.com

Prompt for AI

Ask AI for a custom referral.

Copy into ChatGPT, Claude, or another assistant for a fillable version.

You are an experienced sales-operations document designer for small businesses that grow through introductions.

Create a referral form used when a customer, partner, or employee sends a warm lead. It should record who referred, who the prospect is, what they need, whether you have permission to contact them, reward notes, and who owns follow-up.

Include these sections:
- Your business ([Business name], [Business contact], [Business email], [Business phone])
- Referrer ([Referrer name], [Referrer email], [Referrer phone], [Referrer company])
- Prospect ([Prospect name], [Prospect email], [Prospect phone], [Prospect company])
- Opportunity ([What does the prospect need?], [Urgency: Hot / Warm / Later])
- Permission ([Permission to contact: Yes / Ask first / No])
- Follow-up ([Referral date], [Follow-up owner], [Referral reward notes])
- Explicit note not to collect sensitive identity or payment details on this form

Do not include Social Security numbers, full bank or payment-card numbers, routing numbers, passwords, tax ID numbers, medical details, identity documents, or protected-class information. This is an operational template, not legal, tax, accounting, payroll, collections, or employment advice.

Output a clean fillable template I can copy into a document and adapt. Use a professional tone, clearly labeled sections, and [bracketed] placeholders for every fill-in value. Close with a short practical review checklist.

Recommended books

Books for this form

Practical books that pair with this document. Links use our Amazon Associates ID.

The Referral Engine

John Jantsch

A practical system for turning one happy customer into a repeatable introduction process.

View The Referral Engine on Amazon

The Go-Giver

Bob Burg and John David Mann

Keeps the form about a genuine handoff, not a transactional ask that feels awkward.

View The Go-Giver on Amazon

Fanatical Prospecting

Jeb Blount

Makes sure a warm referral still gets a named owner and a next step.

View Fanatical Prospecting on Amazon

Machine access

JSON Schema

Agents can inspect and validate the same versioned fields. View JSON Schema →

Inspect JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://freebusinessforms.com/schemas/referral-form.json",
  "title": "Referral Form",
  "description": "Record a warm lead from a customer, partner, or employee, including permission to contact and follow-up ownership.",
  "type": "object",
  "additionalProperties": false,
  "properties": {
    "business_name": {
      "title": "Your business name",
      "type": "string"
    },
    "business_contact": {
      "title": "Business contact",
      "type": "string"
    },
    "business_email": {
      "title": "Business email",
      "type": "string",
      "format": "email"
    },
    "business_phone": {
      "title": "Business phone",
      "type": "string"
    },
    "referrer_name": {
      "title": "Referrer name",
      "type": "string"
    },
    "referrer_email": {
      "title": "Referrer email",
      "type": "string",
      "format": "email"
    },
    "referrer_phone": {
      "title": "Referrer phone",
      "type": "string"
    },
    "referrer_company": {
      "title": "Referrer company",
      "type": "string"
    },
    "prospect_name": {
      "title": "Prospect name",
      "type": "string"
    },
    "prospect_email": {
      "title": "Prospect email",
      "type": "string",
      "format": "email"
    },
    "prospect_phone": {
      "title": "Prospect phone",
      "type": "string"
    },
    "prospect_company": {
      "title": "Prospect company",
      "type": "string"
    },
    "need_summary": {
      "title": "What does the prospect need?",
      "type": "string"
    },
    "urgency": {
      "title": "Urgency",
      "type": "string",
      "enum": [
        "Hot",
        "Warm",
        "Later"
      ]
    },
    "permission_to_contact": {
      "title": "Permission to contact",
      "type": "string",
      "enum": [
        "Yes",
        "Ask first",
        "No"
      ],
      "description": "Record whether the prospect agreed to be contacted. Do not collect sensitive identity or payment details on this form."
    },
    "reward_notes": {
      "title": "Referral reward notes",
      "type": "string"
    },
    "referral_date": {
      "title": "Referral date",
      "type": "string",
      "format": "date"
    },
    "owner": {
      "title": "Follow-up owner",
      "type": "string"
    }
  },
  "required": [
    "business_name",
    "referrer_name",
    "prospect_name",
    "need_summary",
    "permission_to_contact"
  ],
  "x-form-version": "1.0.0"
}