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Cargo Insurance Order Form
 For Immediate coverage/policy issued for a Single Shipment or Move.

Purchase Online via Secure order form below.

For All Shipments/Moves, Any Value, Domestic & International by Land, Air or Ocean.
Questions: Call us Toll Free: 1 -800-297-7550

Enter your shipment details below to purchase cargo insurance coverage.
Your policy / certificate of cargo insurance coverage will be issued immediately
(pending payment & approval) and sent to you via email.

If you have NOT received a Quote from us, click "Go"
to view our online cargo insurance rates or get a quote


If you've already received a Quote from us, you may enter your Quote # below. Your Quote is a custom preferred rate for your particular shipment, enter it below to receive your special price. Or you may also purchase immediately without a quote at the "online insurance rates" pricing.

   Individual or Company Name:  Contact Person: 

   Address:      City:    State/Prov:   

   Country:        Zip/Postal Code:       

   Phone:     E-mail Address:                   

Please make sure your Email address is correct, no typos.
This is where your Cargo Insurance Certificate and Payment receipt will be sent.

    Insured Value / Insurance Coverage Amount: $ in US Dollars

Insured value is the total replacement value of your goods being shipped.
For Brand New goods, it's the Invoice price + shipping cost (if you wish to include, optional). 
    For Used goods, it's the estimated / declared actual Replacement cost + shipping / moving
    costs (if you wish to include, optional).

Shipment Date:  

    Name of Insured:  (Person the loss is payable to)

    If it's an individual, please enter the first and last name.        

    Shipment Reference # (BOL #, Pro# , Moving #, Order #, Invoice#, etc): 

    1st Package Type
    Number of boxes, pallets or crates... etc: #     

    2nd Package Type:
    Number of boxes, pallets or crates...etc:  #   (Optional)

Help Example: If you have 20 boxes and 2 crates, under 1st package type you would enter 20 and select "boxes" from the drop down menu and then under Second package type you would enter 2 and then select crates from the menu. If your shipment consists of only 1 package type (for example all boxes) then you can leave the Second package type blank and just fill in the first package type.


    Description of goods being insured:         

    Used Goods     Used & Fully Reconditioned goods     New goods

    ITEMS / GOODS CATEGORY:            

    Click here to View the Category Definitions
 & Determine the Correct Category of Your Goods

  Please use the chart in the link above to ensure you select the
 correct category to be properly covered.



                      Click here to View and Compare Coverage Types
     Name of Shipping Carrier or Moving Company:   

      (The actual carrier who is transporting your goods. If you are using a freight broker
      or moving broker and do not know which carrier, just put the broker name.)

     Mode of Transport:     

     Shipping FROM

     City:  State:    Country: 

     Shipping TO 

     City:  State:    Country:  

Did you receive a quote for this policy by submitting the Quote form, by email, or
      by speaking direct with a P.A.F representative? 

If yes, please enter your Quote below:

Quoted Price: $    Quote #:

Deductible Quoted:

 If the above is a valid Quote, you will be charged this amount.

 Click here to view the Online Rates and
How to Calculate Your Policy Cost
if you have NOT received a Quote

Payment: We do not process credit card transactions through the Internet. We have our own secure credit card terminals, in our offices, for safe processing.  You may safely enter your credit card information below, because it is protected by our Secure SSL Encrypted Website Server and cannot be intercepted or seen by anyone.  Your information will only be seen by us, on our Secure SSL Server, and then the transaction will be processed here in our office, instead of a 3rd party processing company.  However, If you feel more comfortable, you may also call us to give your payment info. over the phone.

       Credit Card: #:---   3 or 4 Digit Security Code:         

Your Credit Card has a 3 digit Security Code found on the back of your card, listed after your credit card number in the signature area. We request that you enter this code as an added security measure. The security code is circled in the example picture on the right.

           Exp Date:               

     I authorize P.A.F to charge my credit card for the cost of this Cargo Insurance Policy, according to the
    Quote I received from a P.A.F representative, plus a credit card merchant fee of 4% of the quoted price with
    a $5 minimum, or if NO quote received then the online rates and category definitions listed on the
Online Insurance Rates" page on this website.  I agree not to charge-back any purchases for
     which service has already been rendered and or for policies I have already received.

Please sign that you agree to the rate/policy charge and terms of the insurance coverage selected
by typing your name:  

Credit Card Billing Address:
Please check this box if the billing address for the credit card is the same as above:
If it is the same, you can leave the fields below blank. If the billing address for the credit card
is different then the address at the top of the form, then please fill in the fields below.

Address:   City:   State:   

Country:    Zipcode/Postal Code:   

Exact Name on Credit Card:      

     How did you hear about us: 

     If Other Company or Search Engine, Please enter Name:
     Who from our company did you speak with or correspond with by email:  

 (who assisted you by email or phone? If you were able to obtain all information
and answers from our website, please select "No one/website" above.  If you spoke with one of our executives via phone or email, please select their name above.) If you are a repeat client/regular customer, then please select the name of the person whom you first spoke with on your very first order.

Letter of Credit Wording if Required by bank or other (Optional):


If you have any other details you wish to provide you may do so in the comments box above. If you were given a quote over the phone, you may enter it here along with the name of the representative who provided the quote.

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Terms and Conditions of Insurance Coverage

I have Read and Agree to the Terms and Conditions of Insurance CoverageYes

By submitting this application order form you agree that you have:
1) Read, understand and agree to the terms and conditions of coverage in the link above.
2) Viewed the category definitions table, linked above, to select the correct category of your items.
3)  If you did not obtain a quote directly from P.A.F, then you agree that you have viewed the online rates chart (linked at the top of this form) and have calculated your policy charge. In absence of a valid quote, this is the amount that will be charged to your credit card today for the purchase of this insurance coverage/policy.



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