P.A.F Insurance Order form for World Logistic Alliance

Cargo Insurance

Questions? Call Us! 800-297-7550
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Cargo Insurance Order Form for clients of:
Purchase Coverage online via Secure order form below.
Instant Coverage/ immediate policy for single shipments

For All Shipments/Moves, Any Value, Domestic & International by Land, Air or Ocean.

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

View the WLA online insurance rates:

dReturn to the WLA Client Home Page

Company Name: Contact Person:

Address: City: State/Prov:

Country: Zip/Postal Code:

Phone: Fax:

E-mail Address:

Please make sure your Email address above is correct, no typos.
This is where your Insurance Certificate will be sent.

    Insured Value / Insurance Coverage Amount: $ in US Dollars

    Insured value is the total replacement value of the 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 the Insured:

    Name Insured = Person the loss is payable to / owner of the goods / your client ).
    Name insured may be a company name or Individual. If it's an individual, please enter
    the first and last name.

Your Shipment Reference # (BOL #, Pro# ,Order#, 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.

INSURANCE COVERAGE TYPE:

                      Click here to View and Compare Coverage Types


     Name of Shipping Carrier :    (actual carrier transporting the goods).

     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 #:

All Risk Deductible Quoted:
(For All Risk Coverage Quotes only)

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 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:

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)

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. Please be assured that any information you submit on our site will be protected by our SSL secured Web Server.

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

By submitting this form you are agreeing that you have:
1) Read, understand and agree to the terms and conditions of the coverage type you selected.
2) Viewed the category definitions table, linked above, to select the correct category of your items.
3) If you did not request a formal quote, then you have viewed the rates chart, linked above, and have calculated your policy charge. This is the amount that will be charged to your credit card for the purchase of this insurance coverage/policy unless you received a Quote from P.A.F.
4) No cancellations/refunds after certificate/policy has already been issued (can transfer coverage to future shipment).

Thank you for you business!