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Commercial Glider Insurance Needs.
Date

Policyholder's Name

Address

Name of Person to Contact

Is policyholder a member of the Soaring Society of America?
YesNo

Occupation/Nature of business

Present Insurance Company (not agent)

Policy expiration date

Airport Name

Aircraft Schedule

* For Uses R= Rental/Instruction, T= Glider Tow for Hire
Applicable to Gliders and Tow Planes

FAA N#	Year Make & Model	Glider Value	R	T	Others	Trailer Value
1.			Yes	Yes
2.			Yes	Yes
3.			Yes	Yes

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