Request a Quote – AIA by Duncan

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Contact Details

621 N. Jackson St., Suite A, Waxahachie, TX 75165

800-232-1953

Working Hours

Monday – Friday 9:00AM – 5:00PM

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Aircraft Make and Model *

Year of Aircraft *

N# *

Value $ *

Number of Seats *

Multiple Choice *

Straight
Tailwheel
Trigear
Retractable

Owner #1 *

Owner #2

Your Name *

First

Last

Your Address ( Street / City / State / Zip ) *

Email *

Cell Phone Number *

Work Phone Number

Home Phone Number

Airport Name #1 *

Identifier # *

Hangered or Tied Out *

Pilot #1 Name *

First

Last

Pilot #1 Date of Birth *

Pilot#1 Certificates *

Student
Private
Commercial
ATP

Pilot #1 Ratings *

Instrument
Multi
CFI
Rotor
MEI

Pilot #1 Memberships *

AOPA
EAA
AND/OR ABS

Pilot #1 Membership #s # *

Total Hours *

Jet Hours

Multi Hours

Retract hours

Tailwheel Hours

Turbine Hours

Hours in Make and Model

Last 12 Total Hours

Last 12 Make and Model hours

Any losses, waivers, violations, DUIs. YES/NO *

Yes
No

If yes, Please explain.

Current date of MED *

Current date of BFR *

Pilot #2 Name

First

Last

Pilot #2 Date of Birth

Pilot #2 Certificates

Student
Private
Commercial
ATP

Pilot #2 Ratings

Instrument
Multi
CFI
Rotor
MEI

Pilot #2 Memberships

AOPA
EAA
AND/OR ABS

Pilot #2 Membership #s #

Total Hours

Jet Hours

Multi Hours

Retract hours

Tailwheel Hours

Turbine Hours

House in Make and Model

Last 12 Total Hours

Last 12 Make and Model

Any losses, waivers, violations, DUIs. YES/NO

Yes
No

If yes, Please explain.

Current date of MED

Current date of BFR

Aircraft Use

Busn - Pleasure
Commercial

If commercial, please explain.

Additional Message

Aircraft Insurance Agency By Duncan

Aircraft Insurance Agency by Duncan, LLC.
P.O. Box 428
Corsicana, TX 75151

800-232-1953