STC REVISION ORDER FORM

 Date:                              Engine Model:                 STC Revision #  
                                

1st Engine S/N                                2nd Engine S/N              Tail #

 Registered Owners Name & Address                                    
Shipping Address if different (NO P.O. Box):

Contact:                                                                                               Phone:              
           

Fax:                                            E-Mail Address:

Purchase Order Number (If applicable)

Please indicate method of payment.  If using a credit card please fax to 775-782-3349.

We will fax a confirmation. 

VISA         MC      AMERICAN EXPRESS          DISCOVER          

WIRE TRANSFER   CHECK     OTHER (We will contact you)

Credit card number:                                                              Exp Date:         Code:

Signature:

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