Aircraft Rental Insurance

Aircraft Rental Insurance Application

WELCOME AHART_AVIATION PILOTS

Note: All fields are required, thank you.

1. Covered Activity Aircraft & Activity:

2. 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.

3. General Information

FBO/Club Name

First Name

Last Name

Years of Age

Occupation

Email Address

Telephone (123-456-7890)

Street Address

City

State

Zip Code

4. Pilot Information

Certificate Student Lightsport/Rec/Private Commercial ATP

Other Certificates

Ratings SEL MEL Instrument Rotorwing

Hours Last 12 Months

Total Hours

In the past
36 months
have you:

1.) Been involved in an aircraft accident or incident? If no, you save 5%.

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

5. Coverage Selection

Liability

Medical Expenses

Physical Damage

6. Discounts

Wings Course, 5%

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

Master CFI, 10%

Yes No

7. 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.

Please start by selecting the correct aircraft type and activity.

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.

Attention FBOs: Click here to add this form to your website.