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General Quote One Pilot
General Information
Registered Owner
Contact Name
Contact Address
Contact City
Contact State
Contact Zip
Email
Contact Phone
Contact Alternate Phone
Contact Fax
Contact Occupation
Do you currently have a policy?
Yes
No
New Purchase
Are you a member of any of the following? (If none, leave blank)
ABS
CPA
EAA
MAPA
PPA
SPA
USAA
Are you a AOPA member?
Yes
No
Is this aircraft a Seaplane?
Yes
No
Does your Aircraft use Skis during the year?
Yes
No
Is your Aircraft laid-up (Stored) for a specific period during the year?
Yes
No
Member Information
ABS Member Number
CPA Member Number
EAA Member Number
MAPA Member Number
PPA Member Number
SPA Member Number
USAA Member Number
AOPA Member Number
Current Insurance Company
Current Policy Begin Date
Current Policy End Date
Aircraft Information
Aircraft Use
Please select...
Pleasure & Business
Commercial
Description of Commercial Aircraft Use
Aircraft Year/Make/Model
Engine Make/Model
Gear Configuration
Tri-Gear
Tail Wheel
Retractable
Airport ID or Name of Airport & Location
Runway Length
Surface Material
Hangared or Tied
Hangared
Tied
Neither
Number of Pilots
One
Two
Three
FAA Number
Total Seats
Agreed Hull Value
Limits of Liability
Please select...
$500,000 CSL / $100k per Passenger
$1,000,000 CSL / $100k per Passenger
$1,000,000 CSL
Other
If other Liability, please explain
Year, Make & Model of Floats
Value of Floats (separate from Hull)
Aircraft on Floats Begin Date
Aircraft on Floats End Date
Make & Model of Skis
Value of Skis (separate from Hull)
Aircraft on Skis Begin Date
Aircraft on Skis End Date
Aircraft Laid-up Begin Date
Aircraft Laid-up End Date
Lien Information
Does your Aircraft have a lien
Yes
No
Lienholder Name
Lienholder Address
Lienholder City
Lienholder State
Lienholder Zip
Lienholder Phone
Lienholder Fax
Lien Amount
Pilot 1 Information
Pilot One Name
Pilot One D.O.B
Pilot One Age
Pilot One Certificates
ATP
Commercial
Private
Student
Recreational
Sport
Pilot One Ratings
Instruments
Helicopter
CFI
Single Engine Land
Multi Engine Land
Single Engine Sea
Multi Engine Sea
Glider
Pilot One Total Hours
Pilot One Total Hours Last 12 Months
Pilot One BFR Date
Pilot One Medical Date
Pilot One Make & Model Hrs
Pilot One Make & Model Hrs Last 12 Months
Pilot One Retractable Gear Hrs
Pilot One Multi Engine Hrs
Pilot One Tail Wheel Hrs
Pilot One Glider Hrs
Pilot One Turbo Prop Hrs
Pilot One Jet Hrs
Pilot One Rotorwing Hrs
Pilot One SeaPlane Last 12 Months Hrs
Pilot One Seaplane Last 3 Months Hrs
Pilot One Single Engine Sea Hrs
Pilot One Multi Engine Sea Hrs
Pilot One Amphibian Hrs
Pilot One Alaska Hrs
Pilot One Make/Model Land Hrs
Pilot One Make/Model Sea Hrs
Pilot One Recurrent Training
Yes
No
Pilot One Completed Sea Wings Program
Yes
No
Pilot One Recurrent Training Completion Date
Pilot One Completion of Sea Wings Program Date
Pilot One Dual Flight Instruction Logged
Pilot One flight schools, recurrency and specific training
Pilot One losses, waivers, violations, cancellations or DWI's
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Contact Falcon Insurance Agency
Feel free to contact us for any business, media, or personal inquiries:
Headquarters Address
Physical:
1001 Water Street, Bld K, Ste 100, Kerrville, TX 78028
Mailing:
P.O. Box 291388, Kerrville, TX 78028
Call Us
Toll Free: (800) 880-4545
Phone: (830) 257-1000
Fax: (830) 792-1144
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