Aircraft Application Home » Aircraft Application Aircraft Application Please Fill out the Form Below Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *AddressAddress 1Address 2City State/ProvinceZip/Postal CodeCountryPhoneFaxHow did you hear about us?OccupationCurrent Insurance CompanyExpiration date of current policyMM/DD/YYYYCheck this box if this is a new purchaseYesAOPA member #EAA member #N#YearMakeModelTotal SeatsInsured Value ($)Base Airport Identifier Base Airport NameMethod of StorageHangaredTied DownDetailsAmount of Loan ($) Is Aircraft on Floats?YesNoPilot Name *FirstLastDate of BirthMM/DD/YYYYLicense TypeStudentPrivateCommercialATPSportRatings (Please choose all that apply)IFRSeaMulti-EngineRotorCFIAny Aviation Accidents, Waivers, Violations, Losses, Incidents, DUI, DWI's?YesNoIf yes, please provide details including the date of the loss and amount paid out by the insurance company.Total HoursIn This ModelRetractable Gear HoursMulti-Engine HoursTail-Wheel HoursTurbo-Prop HoursTurbine-Engine HoursRotor HoursSeaplane HoursOther HoursOther Hours Make and ModelLast 12 MonthsLast school attended in the make and model?When?Where?Liability Limits Requested$1,000,000 combined and single limit including $100,000 per passenger$1,000,000 combined single limit with no passenger limitationOther (specify)All pilots above have a valid and effective pilot certificateYesNoDo you own any other aircraft?YesNoCommentsSubmit
