Dear Valued Customer,

In our efforts to be of better service to you, we ask that you provide the following information when sending your components to us. Please fill in all the blanks and return this signed form by FAX (850) 482-6003 or e-mail to: airprop@airprop.net. Your components will be returned to you with factory finish, unless otherwise specified. Work will begin when we receive this signed form.

Company Name

Address

PO Box

Phone Number

FAX Number

Contact Person

Email Address of Contact Person

Is your component a prop or governor?

Component Manufacturer

Component Model #

Component Serial #

This aircraft operates under the following FAR (Select One):

Tail (Registration) #

Aircraft Manufacturer

Aircraft Serial #

Engine Manufacturer

Total Time of Component

Work To Be Performed

Exact Aircraft Model

Takeoff RPM

Logbook Sent

Engine Model #

Time Since Last Overhaul

STC Information and Special Instructions Such As, Paint, Stripes, Boots, Etc.

Special Paperwork Required

Approximate Date Needed By

How Did Component Arrive?

Electronic Signature

13 + 13 =