Disclaimer:
Any changes requested on this website are NOT official until you receive written confirmation from The Hoxton Agency, Inc.
* Required Fields
Requester Information
*Name of person making request:
*Email of person making request:
*Phone # of person making request:
Policy Information
*Named Insured:
*Policy Number:
*Date you would like the aircraft added:
Aircraft
*Aircraft Registration Number:
*Aircraft Year:
*Aircraft Make:
*Aircraft Model:
*Number of Seats in the Aircraft:
*Base Airport Identifier:
*Base Airport City:
*Base Airport State:
Please select a state
Arizona
Connecticut
Delaware
Florida
Georgia
Maryland
North Carolina
New Jersey
New York
Ohio
Pennsylvania
South Carolina
Tennessee
Virginia
Washington D.C.
West Virginia
Wyoming
*Insured Value:
*Liability Limit:
Please select your desired liability limit
$1,000,000 per occurrence / $100,000 per passenger
$1,000,000 per occurrence / $250,000 per passenger
$1,000,000 Combined Single Limit
$2,000,000 CSL
$5,000,000 CSL
$10,000,000 CSL
$25,000,000 CSL
$50,000,000 CSL
Pilots
*Number of Pilots to Fly Aircraft:
1
2
3
4
5
6
7
8
9
*Are these pilots Named on your policy now?
Yes
No
*If the above answer is "no", please complete a
Pilot History Form
for every pilot you wish to have fly the aircraft.
Pilot Name:
Pilot Make & Model Time:
Notes:
