AGL Aircraft Insurance Quote

• Registered Owner (s)
• Last Name: First Name:
• Street Address:
• City: State:
• Zip Code:
• Work Phone: Home Phone:
• Email Address: Fax Number:
• How did you hear about us?
• Occupation:
• Present Insurance Company:
• Expiration Date: m/d/y
• AOPA Member #:

Aircraft Information

• N#:
• Year:
• Make:
• Model:
• Total Seats:
• Insured Value: $
• Base Airport Identifier:
• Base Airport Name:
• Method of Storage: Hangared
• Tied Down
• Type of Use: Business and Pleasure
• Other (Please Specify)
• Lienholder:
• Amount of Loan: $

Pilot Information

• (If more than one pilot is to be covered please click Add Pilot for each additional pilot.)

  Add Pilot

Coverages

• Liability Limits Requested:
• $1,000,000 Combined Single Limit including $100,000 per passenger
• $1,000,000 Combined Single Limit with no passenger limitation
• Other (Specify)
• All pilots above have a valid and effective pilot certificate:
• Yes
• No
• Do you own any other aircraft?
• Yes
• No
• Please list any aviation accidents, waivers, violations, losses, incidents, DUI, DWI's here.
  Remember to include date and amount of loss.
• Will AGL Aircraft be involved in delivery and/or initial training?
• Yes
• No
• If yes, do you approve the addition of AGL Aircraft as an Additional Insured with Waiver of Subrogation to your quote?
• Yes
• No
• If yes, do you know which AGL Aircraft pilot will be doing the delivery and/or training?
• Yes
• No
• If yes, please enter the Pilot's name here:

Comments

• Please list any comments or questions here: