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Agricultural Aircraft InsuranceQuote Request Form

  • Your Fleet

  • (If more than 7 aircraft, please provide fleet list.)

  • Method of Storage
  • Is This Aircraft Owned by You?
  • Method of Storage
  • Is This Aircraft Owned by You?
  • Method of Storage
  • Is This Aircraft Owned by You?
  • Method of Storage
  • Is This Aircraft Owned by You?
  • Method of Storage
  • Is This Aircraft Owned by You?
  • Method of Storage
  • Is This Aircraft Owned by You?
  • Method of Storage
  • Is This Aircraft Owned by You?

  • (If more than one aircraft please click Add Aircraft for each additional aircraft.)

  • General Aircraft Operations

  • Training in the Use of Chemicals?
  • Industry of State Plant Board Seminars?
  • Have you attended PAASS Professional Aerial Applicator Support System?
  • Are You a Member of the National Agricultural Aviation Association?
  • Are You a Member of a State Aerial Aviation Association?
  • Membership of Any Other Associations?

  • What percentage of total annual application hours involve:

  • Applicant Information

  • General Information

  • Any Accidents, Waivers, Violations, Losses, Claims, Incidents, DUI, DWI or Felonies?
  • Has Any Such Claim Been Made That is Still Unsettled?

  • Premises

  • Any Vehicles Used on Airport Premises?

  • Liability

  • Please Select Appropriate Category
  • Please Select Appropriate Chemical Category

  • Complete Pilot Sectionfor Chief Pilot

  • License Type
  • Ratings
  • Has the Pilot Completed Initial or Recurrent Training in the Last 12 Months?
  • Current BFR?
  • Current Medical?
  • FAA Medical Certificate

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