Please follow the following steps.

• A. Find your current policy (for reference)
• B. Fill out this form, referring to your current policy
• C. You will hear from Joe Ruck within 3 working days
• D. Joe may need further information, and will let you know what to expect from there.

        

                
Your Full Name:   
                
Your E-mail* address:
        
        

                

                

        
        

                


*Note: Please make sure you enter a name and email address so we can contact 
you with a quote. We will treat your E-mail address as strictly confidential
and will not give or sell it to any other person or organization!

AIG Aviation Insurance Services, Inc., one of the insurance carriers we use, 
is currently offering a discount for AOPA members. You need to be a current 
AOPA member to receive that discount, but do not need to purchase 
your insurance through AOPA Insurance Agency (AOPA-IA) to get the 
discount. Please enter your AOPA number and we will obtain that 
discount with any AIG quote:

AOPA number if a current member:  






Aircraft Make and Model? (Show additional planes in "Remarks" below) 
Cessna Cardinal (Fixed Gear)
Cessna Cardinal RG
Other (describe): 

Where is/will Aircraft be based? (name of airport, ID, city, state):

Is/will this aircraft be tied-down or hangared?
    Tied-down
    Hangared

Does this aircraft have any unrepaired damage, special equipment
or major modifications to the airframe or engine(s)?

If different from the name above, who will be 
the registered owner of the aircraft insured?:


Street address or P.O. Box:


City, State, Zip:

Uses of aircraft if other than Non-Commercial, Pleasure/Business:



Do you presently carry an insurance policy on the plane
described above?
No, this would be a new acquisition for me
No, I own it now but it is uninsured - Explain in "Remarks" below)
Yes, Carrier:
                Policy Expiration date: MM/DD/YYYY 


Note: Please supply the name of the carrier, (ie USAIG, Global, AIG,
 etc.) rather than the agent (such asFalcon, AOPA, Aero Insurance)

Very important! For best service you must enter the actual policy 
date, since insurance quotations and other dynamics are date driven.
If you enter an invalid or approximate date it is very likely that we 
will not be able to quote your insurance until it comes up for renewal 
again.

Your requested insurance coverages:

Liability Coverage - Bodily Injury (incl. passengers) & Property Damage
     Please recommend a liability coverage limit
     Please quote:  Combined Single Limit (CSL)
     Sublimit: 
     No Sublimit ("Smooth")

Medical Coverage - Each person, including crew
     Please recommend a medical coverage limit
     Please quote: each person

Other Coverages (If any)
     Certificate for airport
     Certificate for lender - Amount of lien: $
        Name of lender: 
     Other coverages (describe):
     


Pilot Number 1:
     Pilot 1 Name: 
     Occupation:   
     Date of birth (if known) or age:      
     Date Last FAA Medical Certificate:    
     Date Last Biennial Flight Review:     

     Pilot Number 1 - Certificate/Rating(s) held:
            Please Select
           
           Student pilot
           Recreational pilot
           Private pilot
           Commercial pilot
           Airline Transport pilot
            
           Instrument rating

           Airplane Single Engine Land
           Airplane Multi Engine Land
           Certified Flight Instructor
           Other cert/ratings: 

     Pilot Number 1 - Total Logged Flight Hours:
           All aircraft:                  
           Retractable gear:              
           Hours in model to be insured:  
           Last 12-months (all aircraft): 

           Any waivers, limitations (other than corrective lenses),
           accidents or violations? Any DUIs? Also, describe any
           special training (i.e. "Wings") you've had recently:
           

Pilot Number 2:
     Pilot 2 Name: 
     Occupation:   
     Date of birth (if known) or age:      
     Date Last FAA Medical Certificate:    
     Date Last Biennial Flight Review:     

     Pilot Number 2 - Certificate/Rating(s) held:
           
           Please Select
           Student pilot
           Recreational pilot
           Private pilot
           Commercial pilot
            Airline Transport pilot
            
           Instrument rating

           Airplane Single Engine Land
           Airplane Multi Engine Land
           Certified Flight Instructor
           Other cert/ratings: 

     Pilot Number 2 - Total Logged Flight Hours:
           All aircraft:                  
           Retractable gear:              
           Hours in model to be insured:  
           Last 12-months (all aircraft): 

           Any waivers, limitations (other than corrective lenses),
           accidents or violations? Any DUIs? Also, describe any
           special training (i.e. "Wings") you've had recently:
           

Has any insurer cancelled or refused to renew any aviation insurance for you
or any of the pilots submitted herein?
           No
           Yes   (Explain fully in the "Remarks" section below.)


Remarks(Additional planes, pilots, training, particular concerns, etc.)
Also, any OTHER aircraft currently owned by you?  If so, please provide
us with the year, make, model, N-number, name of your insurance carrier
and policy expiration date.:


How did you find us?

        Cardinal Flyers Online
        Cardinal Inspections / KDP Solutions
        Internet Search
        Referral



By clicking the "Submit form" button below, I agree as follows:

 All information herein is warranted to be true to the best of my
        knowledge and no information has been suppressed or withheld;

 This request for a quote does NOT bind any insurance company to
        provide any insurance.