Thank you for your interest in doing business with Evergreen Insurance Managers Inc!
To be considered for an appointment, the following should be
1. Completed Application for Agency Appointment (click here)
2. Copy of current agency license(s)
3. Copy of current E&O and E&O umbrella declarations page, if applicable
4. Completed Request for Taxpayer Identification Number and Certification (Form W-9) (click here)
Note: If you are applying under a business name, that entity must be licensed with the Department of Insurance otherwise you must apply under your personal name.
Please email the above mentioned documents to
the attention of Nancy Schultz,
Incomplete documents will delay the approval process and be returned to your agency.
For additional information on the appointment process, please contact Nancy Schultz for assistance.
We look forward to working with you!!
5293 NE Elam Young Pkwy Ste
Hillsboro, Oregon 97124-7563
© 2006-2011 Evergreen Insurance Managers Inc