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Insurance Coverage purchase form 
For Immediate coverage for a Single Shipment or Move.

Purchase Online via our Secure order form below. We accept all 4 major credit cards.

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

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

If you have NOT received a Quote from us: view our retail insurance rates OR get a Custom Quote at Wholesale rates (preferred lower pricing).

If you’ve already received a Quote from us, enter your Quote # below. Your Quote # is a custom quote at wholesale rates for your particular shipment, enter it below to ensure you receive that price. Or you may also purchase immediately without a quote at the “retail insurance rates” pricing (select this option in the form below).

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


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).


(Person the loss is payable to)
If it’s an individual, please enter the first and last name.
(BOL #, Pro# , Moving #, Order #, Invoice#, etc)
1st Package Type:
2nd Package Type ( 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.

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.

(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.)

Shipping FROM:
Shipping TO:

Received a Quote?

If yes, please enter your Quote below:

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


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.

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.

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 selectedby 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.

(who assisted you by email or phone? If you were able to obtain all informationand 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:

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.

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

Please note that we cannot bind/place coverage over the phone, all insurance purchases must be ordered through this application order form which can be submitted here via this website or by fax and these terms of coverage stated herein must be read and agreed to before we can issue your policy of coverage.
By submitting our application form you are agreeing that you have read and understand the terms and conditions of coverage at: https://www.pafinsurance.com/cargoinsurance-standard-policy-terms/ You may view these terms in another window by clicking the “Terms and Conditions of Insurance Coverage” link beneath this box. Please call us with any questions you have and we’ll be happy to explain.
When purchasing insurance, you certify that all information provided is accurate and truthful. The submission of a false, fictitious, or fraudulent statement may result in imprisonment of up to 5 years and a fine of up to $10,000 (18 USC 1001). In addition, a civil penalty of up to $5,000 and an assessment of twice the amount falsely claimed may be imposed (31 USC 3802). Warning: any fraudulent claims will make the shipper and/or consignee liable for any prosecution for mail fraud under federal crime code.
In order to protect your interest, you, as the cargo owner authorize Pacific Atlantic Freight (PAF) to act as your agent for arranging or assisting with the carriage of your cargo/personal goods in order to procure insurance on your behalf. This will also allow and authorize us to procure the insurance on your behalf and perform any related document preparation for transport and assist with any claims preparation and or activity.
Please make sure you wish to proceed with the purchase of insurance, as there are no refunds or cancellations after the insurance certificate/policy has been issued, unless you need to make a change to the information detailed on the certificate, in which we can cancel the first certificate and issue a new certificate with the correct information. In the case of cancelled shipments, you may apply the policy charge as credit towards coverage/policies for future shipments. This rule helps the insurer to prevent fraudulent orders, i.e.: canceling insurance after the shipment has been delivered safely. In special circumstances, exceptions can be made.

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

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.