Aircraft Rental Insurance Application

WELCOME PACIFIC STATES PILOTS

Note: All fields are required, thank you.

1. Covered Activity
2. Start Date
(mm/dd/yyyy)

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

3. General Information
(123-456-7890)
4. Pilot Information
Student Lightsport/Rec/Private Commercial ATP
SEL MEL Instrument Rotorwing
Fixed Gear Retractrable Gear Tailwheel
In the past
36 months
have you:
Been involved in an aircraft accident or incident? If no, you save 5%.
 
Had an FAA violation?
 
Been convicted of a DUI or crime classified as a felony?
 
Been canceled or declined or refused an aircraft insurance policy?
 
5. Coverage Selection
6. Discounts
Wings Course, 5% (Must have completed advance or master within the last 12 mo.)
Master CFI, 10%
7. Annual 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.

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) 972-0907 if you have questions about getting covered.

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