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General Information
Contact Name:
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Business Name:
Street Address:
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City:
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State/Prov:
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Zip Code:
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Country:
Phone:
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Fax:
Email:
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Aircraft Information
Aircraft Reg. Number:
*
Aircraft Make:
*
Aircraft Model:
*
Aircraft S/N:
Engine Make:
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Select
Continental
Lycoming
Superior
E.C.I.
Engine Model:
*
First Engine Location:
Select
Front
Rear
Left
Right
S/N:
T.S.O.H.:
Spec. #:
Second Engine Location
Select
Front
Rear
Left
Right
S/N:
T.S.O.H.:
Spec. #:
Engine Accessories Requested (at time of overhaul)
Magnetos
Turbocharger
Ignition Harness
Wastegate
Sparkplugs
Relief Valve
Starter
Controller
Carburetor
Oil Cooler
Fuel Injection
Vacuum Pump
GAMIjectors
Other
Alternator
Other
Propeller or Governor Services Requested
Propeller Make:
*
Propeller Model:
*
Propeller Serial Number:
Govenor Make:
Govenor Make:
Govenor Serial Number:
De-Icer Installed?
Yes
No
Propeller Overhaul
Propeller - Prop Strike
Propeller Reseal
Governor - Prop Strike
Governor Overhaul
DESIGNER*PROP
Governor Reseal
Other
Propeller Sales - New
Describe
Propeller Sales - Used
Governor Sales - New
Propeller Sales - Used
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