aviation insurance online application

After you have filled out the form, click the SEND button to submit it.

Name (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Contact Person
Phone (required)
Fax (required)
Name of Airport Based At (required)

Please contact me about the following Avsurance programs:
Workers Compensation
Fixed Base Operators (FBOs)
Corporate/Commercial Flight Operations
Airports and Heliports
Helicopters

To help us provide you with the most competitive quote, please complete the information below.

Airport General Liability


OPERATIONS PERFORMED	RECEIPTS
Fuel/Lubricants
Hangaring
Aircraft Parts
Aircraft Repair
Aircraft Charter
A/C Rental & Instruction
A/C Sales/Units Sold
Avionics Parts
Avionics Repair
Each Aircraft
Engine Overhaul
Prop Overhaul
Accessory Overhauls
FUELING	ANNUAL GALLONS PUMPED
Total Jet
Number of Tanks
Airline
Military
FUEL FARM
Number of Tanks
Capacity
Above or Below Ground


LIABILITY LIMITS
Premises & Products
Hangarkeepers Liability
Each Aircraft
Each Occurrence


AIRCRAFT STORAGE
# of A/C tied down		Hangared
Highest value of A/C tied down		Hangared
Average value of A/C tied down		Hangared


BUILDINGS	SIZE
Office/Terminal		X
Maintenance Hangar		X
Storage Hangar		X
T-Hangars		X
Other Buildings		X


Do you manage the airport?
Are you a tenant or general lessee?


N#	Make/ Model	Year	Seats	Value	Liability Limits	Hours/ Year	Use

State any losses/claims (closed and pending) over the past five years:

If you are sending your application via mail or facsimile, please sign and send to :
Mailing address: Avsurance Corporation, PO Box 1387, Ann Arbor, MI 48106-1387