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Cargo Insurance Rate Request
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 Company Information    
Name of Company*:  
Contact Name*:  
Phone Number*:  
Fax:  
E-Mail*:  
     
     
     
Commodity:  
Number of Shipments Per Year:  
Annual Value of Shipments:  
(Invoice Value + Freight + 10%)
Conveyance:  
Ocean Shipments:  
     
     
     
Origin Countries:  
   
   
   
     
Destinations:  
   
   
   
     
Currently Insured By:  
Current Rate:  
Any Losses in the Last 3 years:   Yes No
     
Please include any additional information that will assist
us in evaluating the specific services your cargo requires.
 
For specialized cargo (Eg. hazardous material, break bulk, overweight, over dimensional, refrigerated, etc),
please contact us at 1-888-510-SHIP
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