Aircraft Rental Insurance

Aircraft Rental Insurance Application

Note: All fields are required, thank you.

Start Date

Desired Start Date (mm/dd/yyyy)

It should be at least 2 days from now, call 800-972-0907 if you need it sooner.

General Information

First Name

Last Name

Years of Age

Occupation

Email Address

Telephone (123-456-7890)

Street Address

City

State

Zip Code

Pilot Information

Certificate Student Lightsport/Rec/Private Commercial ATP

Other Certificates

Ratings SEL MEL Instrument Rotorwing

Hours Last 12 Months

Total Hours

Endorsements Fixed Gear Retractrable Gear Tailwheel

In the past
36 months
have you:

1.) Been involved in an aircraft accident or incident?

Yes No

2.) Had an FAA violation?

Yes No

3.) Been convicted of a DUI or crime classified as a felony?

Yes No

4.) Been canceled or declined or refused an aircraft insurance policy?

Yes No

Explain "Yes" Answers

Coverage Selection

Liability

Medical Expenses

Physical Damage

Discounts

Wings Course, 5%

Yes No (Must have completed advance or master within the last 12 mo.)

Master CFI, 10%

Yes No

Annual Premium

Total Premium

* Note: Coverage will not be in-force until you receive an actual policy number from us

Protect Yourself First!

Complete this form to start the process of getting your own insurance when you rent or borrow aircraft. Non-Owned Aircraft means a fixed wing nonpressurized land (including sailplanes/glider) having a single piston engine not exceeding 450 rated horsepower, and no more than 7 total seats.

Coverage for Bodily Injury and Property Damage arising from your use of Non-Owned Aircraft
Medical Expense Available for you and your passengers
Optional Non-Owned Physical Damage Liability Including Loss of Use of Non-Owned Aircraft
Coverage for your aircraft deductible liability up to $5,000
Baggage $1,000 each passenger
Hangars and Contents $25.000 each occurrence
Experimental, Light Sport Aircraft are Included.

Take a few minutes to protect your future with your non-owned aircraft policy today!

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Please call Aviation Marine Insurance Services at 800-972-0972 if you have questions about getting covered.

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