Please enable JavaScript in your browser to complete this form.1Basic Information2Aircraft3Pilot Info4Additional InformationFull Name *Street Address *City *State *Please enter your two letter State code. E.g. "MN" instead of "Minnesota'Zip/Postal Code *Cell Phone *Email *Projected Delivery Date *Please enter in MM/DD/YYYY formatNextYear *Select One20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003Model *Select OneSR20SR22SR22TSF50N-NumberIf unknown, please enter NTBDPurchase Price *Base Airport ID *Will the aircraft be hangared at the base airport? *YesNoDo you currently own this aircraft? *YesNoPreviousNextHow Many Pilots? *Select Number of Pilots12345Press to select (1-5)Pilot 1Full Name (Pilot 1) *Date of Birth (Pilot 1) *Please enter in MM/DD/YYYY formatLicense Type (Pilot 1) *Select OneStudentPrivateCommercialATPCFIIFR Rated? (Pilot 1) *YesNoTotal Logged Hours (Pilot 1) *SR20 Logged Hours (Pilot 1) *SR22/SR22T Logged Hours (Pilot 1) *SF50 Logged Hours *Turbine Logged Hours *Total Hours Logged in the Last 12 Months (Pilot 1) *Date of Last Medical Certificate (Pilot 1)Any Medical Limitations (if yes, explain below) (Pilot 1)YesNoAny aviation accidents, incidents, waivers, violations, losses, DUI's, Felonies, etc.? (Pilot 1) *Please enter 'None' if not applicablePilot 2Full Name (Pilot 2) *Date of Birth (Pilot 2) *Please enter in MM/DD/YYYY formatLicense Type (Pilot 2) *Select OneStudentPrivateCommercialATPCFIIFR Rated? (Pilot 2) *YesNoTotal Logged Hours (Pilot 2) *SR20 Logged Hours (Pilot 2) *SR22/SR22T Logged Hours (Pilot 2) *SF50 Logged Hours (Pilot 2) *Turbine Logged Hours (Pilot 2) *Total Hours Logged in the Last 12 Months (Pilot 2) *Date of Last Medical Certificate (Pilot 2)Any Medical Limitations (if yes, explain below) (Pilot 2)YesNoAny aviation accidents, incidents, waivers, violations, losses, DUI's, Felonies, etc.? (Pilot 2) *Please enter 'None' if not applicablePilot 3Full Name (Pilot 3) *Date of Birth (Pilot 3) *Please enter in MM/DD/YYYY formatLicense Type (Pilot 3) *Select OneStudentPrivateCommercialATPCFIIFR Rated? (Pilot 3) *YesNoTotal Logged Hours (Pilot 3) *SR20 Logged Hours (Pilot 3) *SR22/SR22T Logged Hours (Pilot 3) *SF50 Logged Hours (Pilot 3) *Turbine Logged Hours (Pilot 3) *Total Hours Logged in the Last 12 Months (Pilot 3) *Date of Last Medical Certificate (Pilot 3)Any Medical Limitations (if yes, explain below) (Pilot 3)YesNoAny aviation accidents, incidents, waivers, violations, losses, DUI's, Felonies, etc.? (Pilot 3) *Please enter 'None' if not applicablePilot 4Full Name (Pilot 4) *Date of Birth (Pilot 4) *Please enter in MM/DD/YYYY formatLicense Type (Pilot 4) *Select OneStudentPrivateCommercialATPCFIIFR Rated? (Pilot 4) *YesNoTotal Logged Hours (Pilot 4) *SR20 Logged Hours (Pilot 4) *SR22/SR22T Logged Hours (Pilot 4) *SF50 Logged Hours (Pilot 4) *Turbine Logged Hours (Pilot 4) *Total Hours Logged in the Last 12 Months (Pilot 4) *Date of Last Medical Certificate (Pilot 4)Any Medical Limitations (if yes, explain below) (Pilot 4)YesNoAny aviation accidents, incidents, waivers, violations, losses, DUI's, Felonies, etc.? (Pilot 4) *Please enter 'None' if not applicablePilot 5Full Name (Pilot 5) *Date of Birth (Pilot 5) *Please enter in MM/DD/YYYY formatLicense Type (Pilot 5) *Select OneStudentPrivateCommercialATPCFIIFR Rated? (Pilot 5) *YesNoTotal Logged Hours (Pilot 5) *SR20 Logged Hours (Pilot 5) *SR22/SR22T Logged Hours (Pilot 5) *SF50 Logged Hours (Pilot 5) *Turbine Logged Hours (Pilot 5) *Date of last Medical Certificate (Pilot 5)Any Medical Limitations (if yes, explain below) (Pilot 5)YesNoAny aviation accidents, incidents, waivers, violations, losses, DUI's, Felonies, etc.? (Pilot 5) *Please enter 'None' if not applicablePreviousNextAny additional information you'd like to provide?Sign up for SMS AlertsBy providing your phone number, you agree to receive text messages from Wings Insurance. Message & data rates may apply. Message frequency varies. Reply HELP for help and STOP to cancel.View Terms of Use and Privacy Policy in links below. Submit Ryan Konrath Insurance Broker Sara Weidler Account Manager SMS Terms of Use SMS Privacy Policy
