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Black Diamond Financial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Request a Certificate

  • Our Certificate of Insurance service is free!  It's fast!  Your requests will be processed, and you will receive confirmation within 24 business hours. 
  • You can rely on us! We will call you with any questions and we will send you a copy of the Certificate for your records. 
  • We're flexible!  You choose how you want the Certificate delivered to the Certificate Holder. 
  • It's simple and easy.  Just complete the information below and click send.

    Please note that special requests may require insurance carrier approval.  Fax or email us all special requirements or applicable contracts and we will review them for you.
     

Today's Date:
Name of Insured:*
How would you like the Certificate of Insurance delivered to the Certificate Holder?
Name and Mailing Address of Certificate Holder:
Fax or E-mail Address of Certificate Holder:
Special instructions for completion of the certificate:
Please explain the Certificates Holders interest in your insurance.  Are you doing work for this person/entity?  If so please give a brief description of the work being performed:
Person completing this certificate request:*
Phone number of person completing this request:*
Best time to reach if we have questions?*
Best way to contact?*
  *These fields are required
Thank You!

Please remember that an insurance certificate does not change, alter, amend or add coverage to your policy.  Changes to your policy must be endorsed to your policy.  Contact our office to make any change to your coverage.  Certificates are for informational purposes only.

NOTE:  Online forms are neither secure nor entirely reliable.  If you are a policyholder or prospective policyholder and require policy changes or binding of insurance coverage, you must contact our office at 541-382-1611 or toll free at 888-382-1611 during business hours.  Sage Insurance is not responsible for acting or failing to act on form request we receive or do not receive.

Our form completions are for information gathering only.  Any form submission in no way constitutes insurance coverage nor does it legally bind our agency or the companies that we represent for any coverage to anyone who completes and SUBMITS a form.