UAV and Drone Insurance Quote

• Company Name
• Applicant's Name First Last
• Phone
• E-mail
• Street Address:
• City State: AL AK AZ AR CA CO CT DE DC FL GA HA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
• Zip Code:
• Business of Applicant / Occupation
• Describe all incidents, accidents, claims (hull and liability) with dates and amounts paid (even if none), which occurred in the last five years

• UAV INFORMATION

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• PURPOSE OF USE

• CHECK ALL APPLICABLE USES

  Police Fire Search & Rescue Surveillance Photography Wildlife Observation Construction/Engineering Industrial Video/Film Production Communications Pipeline/Powerline Patrol Flight Testing/Demonstration Thermal Imagery Aerial Marketing Employee Training Crop Management Mapping Military (Non-Combat) Cargo/Freight Carrying Real Estate Sales Atmospheric/Weather Research
• Do you provide third party instruction with your UAV?

  Yes No
• Indoor Use?

  Yes No
• If yes, explain
• Do you have your FAA Part 107?

  Yes No
• If no, explain
• Liability Limit requested: $1,000,000 $2,000,000 $3,000,000 $5,000,000 Other
• Other:
• Comments

• Pilots

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• Do Not Fill This Out