logo1
logo2
 
logo3
Home
Calendar of Events
IBDA Safety Manual
Knowledge Base Main
Resources
Interesting Birddog Info
Monthly Bark Archives
IBDA Directors
IBDA Aircraft Insurance
nav bottom
 
 

On Line Quote Request

QUOTE REQUEST
Please fully complete the following data form, and simply click the "Request Quote" button and we will contact you with an aircraft insurance quotation or print out the quote form and mail or fax to us:
IBDA Aircraft Insurance Plan
Falcon Insurance Agency, Inc.
P.O. Box 291388
Kerrville, TX 78029
Phone (866-292-IBDA (4232)
Fax (830)792-1144

* = required fields
 

PERSONAL INFORMATION

IBDA Member     yes     no
*Registered Owner  
*Contact Name  
*Address  
*City  
*State  
*Zip  
*Email  
*Daytime Phone  
Evening Phone
Fax
Cell Phone:
*Occupation  
New Purchase Yes      No
*Expiration Date of Current Policy   
(if 'new purchase' or 'none', please indicate)
*Current Insurance Company
 		  
 (if 'new purchase' or 'none' please indicate)
  
AIRCRAFT INFORMATION
*Description of Aircraft Use  
(if commercial use, explain here)
Aircraft Information  
*Year  
*Make  
*Model  
*Aircraft FAA Number  
 (if "new purchase" or "unknown" please indicate)
*Total Seats  
If experimental, provide Engine Make and Model:
Engine Make
Horsepower
*Airport Location  
*Hangared or Tied?  
Airport Identifier
(4 digit, alpha/numbers)
Runway Length
Surface Material
Elevation
Obstructions
*Insured Hull Value  
 (Including all attached equipment, i.e. floats)
*Hull Coverage  
*Limits of Liability  
*Medical Payments  
*Is aircraft a Seaplane?  
*Is aircraft based in Alaska?  
 (if yes, you will be asked to provide some additional information necessary to process your quote)
Lien Holder Name  
Lien Holder Address
City
State
Zip
Fax
Lien Amount

   

PILOT INFORMATION
*If aircraft is retractable gear, multi-engine, tailwheel, turbo-prop, jet powered, or rotorwing, please specify total logged hours for each category.
1. *Pilot(s) Name
 
   *Occupation
 
*Age *Certificate Ratings
(check all that apply)		 *Total Hours *Total Hours
Last 12 Months
Instrument
Helicopter
CFI
Single Engine Land
Multi Engine Land
Single Engine Sea
Multi Engine Sea
Glider
*BFR Date *Medical Date *Your hours in this aircraft
RG hrs ME hrs TW hrs Turbo Prop Jet hrs RW hrs
   RG=Retractable Gear ME=Muti-Engine TW=Tailwheel RW=Rotorwing
Have you had any of the following in the last 5 years?
Yes     No -  *Drug or alcohol conviction
Yes     No -  *Pilot or driver's license surrender or revocation
Yes     No -  *Accidents, incidents or claims
Yes     No -  *FAA/FAR citations/violations/suspensions
Please list flight schools, recurrency and type specific training.
 
Please list any losses, waivers, violations, cancellations or DWI's.
  
      

2. Pilot(s) Name
   Occupation
Age Certificate Ratings Total Hours Total Hours
Last 12 months
Instrument
Helicopter
CFI
Single Engine Land
Multi Engine Land
Single Engine Sea
Multi Engine Sea
Glider
BFR Date Medical Date Your hours in this aircraft
RG hrs ME hrs TW hrs Turbo Prop hrs Jet hrs RW hrs
   RG=Retractable Gear ME=Muti-Engine TW=Tailwheel RW=Rotorwing
Have you had any of the following in the last 5 years?
Yes     No -  Drug or alcohol conviction
Yes     No -  Pilot or driver's license surrender or revocation
Yes     No -  Accidents, incidents or claims
Yes     No -  FAA/FAR citations/violations/suspensions
 
Please list flight schools, recurrency and type specific training.
 
Please list any losses, waivers, violations, cancellations or DWI's.
   
3. Pilot(s) Name
   Occupation
Age Certificate Ratings Total Hours Total Hours
Last 12 months
Instrument
Helicopter
CFI
Single Engine Land
Multi Engine Land
Single Engine Sea
Multi Engine Sea
Glider
BFR Date Medical Date Your hours in this aircraft
RG hrs ME hrs TW hrs Turbo Prop hrs Jet hrs RW hrs
   RG=Retractable Gear ME=Muti-Engine TW=Tailwheel RW=Rotorwing
Have you had any of the following in the last 5 years?
Yes     No -  Drug or alcohol conviction
Yes     No -  Pilot or driver's license surrender or revocation
Yes     No -  Accidents, incidents or claims
Yes     No -  FAA/FAR citations/violations/suspensions
 
Please list flight schools, recurrency and type specific training.
 
Please list any losses, waivers, violations, cancellations or DWI's.


     
International Birddog Association               email webmaster