Pilot Experience & Lease Application

Tell us about you, your flying experience, and the aircraft you want to lease.

Lease A Cirrus offers dry leases under 14 CFR Part 91 — we are not a Part 135 charter operator and do not provide flight crew. The pilot details below are for lease eligibility and insurance screening; as the lessee you provide, and are responsible for, a qualified and current pilot.

Your details

Your name

Account email

Phone

Applying as

Business / entity name

Who will fly the aircraft?

I'll fly it myself I'll provide a hired pilot

Pilot — personal

Pilot name

Date of birth

Airmen cert #

Address

City

State

Zip

Employer

Occupation

AOPA #

Work phone

Cell phone

Pilot email

Emergency contact

Name

Relationship

Phone

Certificates & ratings

Certificate level

Ratings

Instrument

Multi-engine

Seaplane

Rotorcraft

CFI

CSIP

Type ratings & LOAs

Total logged hours

Total time

PIC

SIC

Multi-engine

Retract

Tailwheel

Instr actual

Instr sim

Turbine

Jet

Turboprop

Seaplane

Rotor

Dual given

Last 90 days

Last 12 mo

Time in type

Make & model experience

Make	Model	Total hrs	Last 12 mo	Training?	School / course	Date

Medical & currency

Medical class

Medical date

Last flight review

Last IPC

Special issuance / SODA / limitation

Vision correction

Color blindness

Other condition

If any limitation, explain

Disclosures (last 5 years)

Check any that apply and add detail.

Aircraft accident / incident / claim

Insurance cancelled / declined / non-renewed

FAR violation

DUI (alcohol/narcotics)

Reckless driving conviction

Drug/narcotics conviction or indictment

Driver's license suspended/revoked

Felony conviction

Aircraft owner group member

Accident date (if any)

Amount of damage/paid

Which aircraft?

One in your fleet A type you don't stock

Anything else?

I warrant the answers given are true and complete to the best of my knowledge.