Application (RTP)


Are you ready to start saving money on every parcel that you insure? By completing a "U-PIC Request to Provide", you are on your way to big savings and great service. Sign up to become a U-PIC client today! Purchasing for a single package only? You do NOT need to complete this form! Instead visit the Buy Online  page. This form is to apply for volume pricing only.

INSTRUCTIONS

To become a U-PIC client, please provide the information listed below. Upon submittal, a U-PIC representative will contact you shortly.

About You
Company Name:
Address:
City:
State:
Zip Code:
Title:
Contact name:
Phone:
Fax:
Email Address:

Opt-In for electronic only notice/updates for your account. By checking this box you agree to receive all notifications on your account by electronic means. You also agree and confirm that your computer is able to access the PDF files used for request. Should you wish to opt-out of this paperless service to receive these notices through US Postal Mail, please email us at support@u-pic.com or simply call us at (800) 955-4623 option 1.

Shipping Info
Packages Shipped Per Month:
Packages Insured Per Month:
Maximum Value Per Package: $
Average Value Per Package: $
Commodity Shipped (please be specific):
Do you ship internationally ?
Shipping Software:





Others:
Start Date: (would like coverage to begin on*)
  mm/dd/yyyy
*U-PIC does not guarantee that a policy will be issued or that this Start Date can be met.
Carriers (Choose all that apply.)
Percentage of Parcels moving with Carriers
UPS / DHL / Fed-Ex:
USPS/DHL Gobal/Fed-Ex Smart Post
or UPS mail Innovations
Claim History (A 2 year Claim history required for coverage)
How many claims in last 2 years:
Total dollar value of claims in last 2 years: $
Comments
Please tell us how you heard about us : RETAIL
Agreement
  1. Understand the terms of this coverage and acknowledge receipt of a sample copy of the policy (Evidence of Insurance). Please pay special attention to #3(b) as it pertains to packaging.
  2. Agree to pay each month's insurance premium before the 10th of the following month.
  3. Will correctly report all parcels shipped by the carrier(s) during the period of this coverage, and agree that Underwriter reserves the right to audit all reports.
  4. Understand that this policy does not cover a carrier's automatic coverage, if any.
  5. Understand that I have 90 days from the shipment to submit a claim for payment to U-PIC when using the United States Postal Service.
Terms

By signing below, you irrevocably agree to all of the terms and conditions of this agreement. Please note, your acceptance of and compliance with the terms and conditions of this agreement are a condition of your right to use U-PIC provided package insurance. Using U-PIC provided package insurance affirms your acceptance of this agreement and all terms and conditions.