By checking this box and clicking “Send” below:

-You acknowledge that coverage is not guaranteed, bound, or altered with payment.

-You consent and authorize Evergreen Insurance, LLC or its representative to collect your insurance premium by charging your credit card or by debiting your checking account via ACH.

-You agree that it is your responsibility to have sufficient funds in the account being charged. You understand that insufficient funds could ultimately cause your policy to be cancelled or expire.

-You acknowledge that although one amount will be charged to your credit card/bank account, the credit card/ACH fee portion is assessed by and is forwarded directly to ePayPolicy. ePayPolicy charges a 3.50% processing fee for credit card payment or 1% processing fee (up to a maximum of $5.00 per transaction) for ACH payments. Such fees are separate charges by ePayPolicy, an independent company not affiliated with Evergreen Insurance, LLC. Evergreen Insurance, LLC does not collect or hold these processing fees at any time.

-You acknowledge that you are responsible for reviewing any invoices, statements or billing notices presented to your mailing address and/or email address on file with us. If your mailing address and/or email address changes, you will promptly notify us. Failure to update your mailing address and/or email address with us may delay delivery of your invoices, statement or billing notices, which in turn could delay payment and ultimately cause your policy to be cancelled or expire.