Date of Order

PO Number

Order Taken By:

Customer Information

Customer/Owner Name

First

Last

Customer/Owner Address Information

Address Line 1

Address Line 2

City

State

Zip Code

Is this a C150/152 Pre-Order

YES
NO

Customer/Owner Email

Email

Confirm Email

Customer/Owner Phone

Aircraft Information

Aircraft Model

Aircraft Year

Cessna Only - Does or Did this Plane have a NavoMatic Autopilot

Yes
No

Serial Number

Registration- Tail Number

GPS Being Used

EFIS if any being used.

If you have a and EFIS list here: ex: Av30C, Aspen, Garmin G5...

Request EFIS Unlock Upgrade

Yes
No

Currently Available for G5 and Aspen Systems Cost is $200.00

Voltage 12 0r 24

12 Volt
24 Volt

Mounting Choice

3 1/4 Instrument Mount
Panel Rack Mount

Need By Date

We will do our best to accommodate but can not guarantee this date.

Notes:

Shipping Information

Shipping Address

Same AS Customer/Owner Above

Shipping Contact Name

First

Last

Shipping Address

Address Line 1

Address Line 2

City

State

Zip Code

Shipping Phone

Ship to Email

Receive Date Requested

Installer Information

Installer Name/Business Name

Installer Phone

Installer Email