Aaxia Chemical Insurance Services®

North America's Leading Chemical Insurance Specialist

OCEAN MARINE CARGO / OPEN CARGO
COVERAGE APPLICATION


First Name
Last Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
Fax() -
E-mail Address
Number of Containers Shipped Per Month?
Average Value of Each Container?
Shipping Origins / Destinations (From Where...to Where?) ie. U.S. to World - or U.S. to U.S. etc.
List Top 3 Cities Your Company is Importing From
List Top 3 Cities Your Company is Exporting To
List Top 5 Products Being Shipped
Total Gross Sales
Registered Tradmark®

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