Get a Quote

Please fill out the following form and click on the "Submit" button. If you prefer click here for a printable pdf to either fax or mail. Quote is for non-commercial use. Coverage is available for U.S.-based aircraft; to view the policy territory and the Avemco policy click here.

If you need coverage for Non-Owned Aircraft please click here.

* Required Fields

  

First Name:* M.I.:*	Last Name:*
Address:*
City:*	State:* AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:*	Day Phone:*
Evening Phone:	Cell Phone:
Fax:	Email:*
Occupation:	Desired Effective Date:
Current Insurer:	Current Expiration Date:
Current Annual Premium:	Registered Owner:*
Is Registered Owner a Corporation?* YesNo	Aircraft use:* Pleasure & Business Industrial Aid (Pro Flown) Non-Commercial Flying Club
If Flying Club # of Members: N/A 6-10 11-15 16-20 (if more than 20, contact Avemco)	How did you hear about us? Please Choose Received Mailing Magazine Ad Link from Website Past Customer Referral Aero Trader Aircraft Dealer Network Aircraft Marketplace AOPA e-News AV WEB Aero News Trade-A-Plane Plane & Pilot Other
Is this a New Purchase?* YesNo	Name of Business that referred you:

Section B - Aircraft Information

Aircraft Make/Model:*	N #:
Year Manufactured:	Experimental/Amateur Built:* YesNo
Engine Make:	Engine Horsepower:
# Seats Including Pilot:*	Aircraft Type: Land Sea Amphibian
Hangared? YesNo	Base & Location (City, State):*
Lienholder Name (if applicable):	FAA Airport Identifier:*
Aircraft current w/annual/periodic inspection?	YesNo
If no, please explain in additional information box below

Section C - Pilot Information           Same as Section A

First Name:* M.I.:*	Last Name:*
Address:*
Date of Birth (mm/dd/yy):*	Age:**
Certificate Type: STU PVT COM ATP SPORT	Ratings: ASEL AMEL ASMEL AMELS ASES ASMELS GLIDER
Instrument:* YesNo	Total Hours (All Aircraft):*
Tailwheel Hours:*	Retractable Gear Hours:*
Multi-Engine Hours:*	Constant Speed Prop Hours:*
Glider Hours:*	Sea Plane Hours:*
Make/Model Hours:*	Hours Last 12 Months:*
Valid Medical for FAA Certificate:* YesNo	Current FAA Flight Review:* YesNo
*Been cancelled, declined, or refused renewal on an aircraft insurance policy? (Does not apply in Missouri)	YesNo
*Been arrested or charged with operating an aircraft or motor vehicle while under the influence of drugs or alcohol?	YesNo
*Been convicted of, or pleaded "guilty" or "no contest" to any felony or misdemeanor other than parking violations?	YesNo
*Accidents/Incidents/Suspensions/Claims:	YesNo
*DUI/DWI:	YesNo
Add'l certificates, ratings or recurrent training in last 12 months:* YesNo
*If YES to any of the above 6 questions, please provide details in the "Additional Information" box at the end of this form.
FAASTeam WINGS Knowledge Course Completion: (List course title. Course must be valued at 1 full credit or more).
Course Title:
Is there a Second Pilot?* YesNo

Section D - Coverage Information

Liability Limits - Select one*
Bodily Injury Property Damage Per Occurrence $50,000 $500,000 $500,000 $100,000 $500,000 $500,000 $100,000 $1,000,000 $1,000,000
NOTE: (Other limits may be available. Please contact us for more information)
Aircraft Damage - Hull Coverage (Optional)
Aircraft Insured Value: $
Choose an Option:	Flight & Ground Ground Only None
Medical Payments - Select One (Optional)
None $1,000 $2,500 $3,000 $5,000
Additional Information: Use the box below for additional information on items above or for questions/comments. If there are more than 2 pilots, include pilot information as requested above.
Avemco is committed to protecting your privacy. Avemco uses techniques to encrypt, safeguard, and secure your personal informaiton. To view our Privacy Policy prior to applying for coverage click here.

All quotations are valid for 30 days, and are subject to review by Avemco's underwriting staff prior to binding. This quotation also assumes that all pilots have had no claims, accidents, incidents, pilot certificate actions, or drug or alcohol convictions in the past 36 months.

NOTE: We cannot stop, start or amend coverage by this form request. A quote will be mailed to you within 48 hours. If you have any questions or need a quote sooner, please call toll-free (888) 241-7891 and ask to speak to an Aviation Underwriter who will be happy to assist you.

Thank you for your interest in Avemco Insurance Company.