Shipping Insurance Form-Lower Than $250K

Please fill out the following form to be covered under MIT's shipping insurance. Any questions please contact Sarah Brown.

Contact Name (MIT) *

Email *

Phone *

Department Name *

Shipping Company Name *

Shipment Origin

City *

Country *

Shipment Destination

City *

Country *

Date of Shipment *

Year

Month

Day

Will this be returned *

Yes

Return date *

Year

Month

Day

Description of Equipment *

Value of Equipment *

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