"AAIRRG Non-Binding Indication Form"
AAIRRG NON-BINDING INDICATION Thank you for your interest and for providing some of your time to fill out this form. We look forward to reviewing it and providing you with a non-binding indication. Based on this preliminary information, we will be able to provide you with an estimated annual premium. You can learn more about AAIRRG at www.aairrg.com or www.arsa.org/AAIRRG. All information will be held in the strictest of confidence by Polaris. Polaris is the facilitator and administrator of AAIRRG and is a professional insurance firm. No individual revenue figures will be revealed to ARSA or to any others within the repair station industry. We will look forward to speaking with you very soon. If you have any questions, please feel free to contact us at 415-885- 2700 or send an email to email@example.com. When completed, first save and then please paste firstname.lastname@example.org in the To: line AAIRRG NON-BINDING INDICATION FORM Name: Company: Address: City, State & ZIP Code: Direct Phone Number: Email Address: Website: www. Please provide your estimated 2009 revenues for each FAA Rating Class 1 Class 2 Class 3 Class 4 Limited Accessory Airframe Instrument Power plant Propeller Radio LIMITED RATINGS Emergency Equipment Aviation Alliance Insurance Risk Retention Group, Inc. (www.AAIRRG.com) Page 1 of 2 AAIRRG NON-BINDING INDICATION Aircraft Fabric Non-Destructive Testing Floats Specialized Service Rotor Blades Landing Gear Other INSURANCE INFORMATION Limits of Liability Required? Grounding Limit Hangerkeepers Limit Any Claims Past Five years? On what month does your Aircraft Products Liability Insurance renew? ADDITIONAL REMARKS Aviation Alliance Insurance Risk Retention Group, Inc. (www.AAIRRG.com) Page 2 of 2