Buy Now Single Shipment Form

This form is designed to help you purchase insurance for a single package originating in the U.S. or Canada.

Need to Insure Multiple Shipments?

Contact our team at 800-955-4623 or sales@u-pic.com if you have any questions.

Company

Name

Address

City

Country

State

Zip

Phone

Fax

Referred by

Ship date

Commodity

Is this jewelry?

Is this commodity covered? - View Coverage Rules

Insurance value

Recipient company

Recipient name

Recipient country

Recipient state

Recipient zip

Reference

Tracking number

Carrier

Service

Want to save time on future shipments? Check the box below to create a web account for autofilled forms.

Create web account?

The insurance value must be more than zero to insure a shipment.

Need to insure multiple shipments?

If you have multiple shipments to insure, our multiple shipment form may be the best option for you.

Enter all your shipments and pay one time