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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. |
Packaging:
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.
INSURANCE COVERAGE TYPE:
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:
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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.
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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.
YES
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):
Comments:
(Optional)
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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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Click
image above to Verify
SSL
stands for Secure Sockets Layer and
is the Internet's leading Security
Protocol, designed to prevent the
interception of private or sensitive
information sent over a computer
network or the Internet. (I.e.:
protection against hackers). SSL
enables encrypted, authenticated
communications across the internet
ensuring that all online
communications are secure and cannot
be intercepted while in transit.
Please be assured that any
information you submit on our site
will be protected by our SSL secured
Web Server.
Terms and Conditions of Insurance Coverage
I have Read
and Agree to the
Terms and Conditions of Insurance
CoverageYes
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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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