Vehicle or Vessel Cargo Quote - Bertram Insurance Service

Shipment Origin (City & State)

Shipment Destination (City & State)

Value Of Goods (C)*

Freight Charge (F)*

Estimated Shipping Date*

Name of Shipping Company*

Booking number

Vehicle year make and model*

Serial or Vehicle Identification Number*

Finance company or lienholder information

If there is a finance company or lienholder, provide the company name and address. They will be added as a loss payee.

Total increased by 10% (C+F+10% per Admiralty Law)

Total Insured Value

Deductible

Total premium

First Name*

Last Name*

Company Name (If Applicable)

Phone Number*

Email Address*

Address*

Address 2

City

State*

Zip code*