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Pilot Authorization Form
Please fill out the information below as completely as possible, then click "Submit" at the bottom. (*All Fields Required.)
Pilot Authorization Form
Select Your Location
Venice (VNC)
Sarasota (SRQ)
Lantana (LNA)
Tampa (TPF)
Punta Gorda (PGD)
Contact Information
Customer Name:
Company (Optional):
Phone:
Email:
Aircraft Information
Tail #:
Make/Model:
Pilot Authorization
Please indicate your approval of this permission by checking the appropriate boxes:
I have reviewed the requirements of aircraft insurance on this aircraft, and confirm that Sarasota Avionics Inc.'s (SAI) pilot will meet the requirements of Owner's insurance on this aircraft.
Yes
No
I certify that the aircraft complies with state and Federal Aviation Regulations (FAR) applicable to the aircraft described in this Agreement, and specifically confirms that this aircraft is in airworthy condition. Owner understands that Owner is responsible for keeping current with all regulations while Owner's aircraft is in the possession of SAI.
Yes
No
The aircraft described in this Agreement has a current annual inspection as required by FAR. Owner understands that Owner is responsible for keeping Owner's annual inspection current during any period while Owner's aircraft is in the possession of SAI.
Yes
No
I certify that the Owner has an aviation Hull / Liability policy on the aircraft described in this Agreement. If the policy is cancelled or expires, Owner agrees to immediately notify SAI in writing of that event.
Yes
No
This Agreement applies only to the described aircraft. If there are changes in the described aircraft or Owner's pilot status, Owner agrees to submit a new Agreement to SAI.
Yes
No
An express mechanic's lien is hereby acknowledged in this aircraft to secure the amount of repairs thereto. If it becomes necessary for Sarasota Avionics ("SAI") to employ a collection agency and/or attorney to collect this account, I agree to pay all court costs plus a reasonable attorney's fee and/or collection agency fee. The fact that I may have insurance does not release me of my personal responsibility of payment. I understand it is my option to leave my personal effects in the aircraft. SAI will not be held responsible for loss or damage to the aircraft or articles left in case of fire, theft, or any cause beyond its control. Customer shall not be entitled to recover from the company any consequential damage to property, damage for loss of use, loss of time, loss of profits or income, or any other incidental damages. The balance for equipment purchased is due by check or wire transfer when aircraft arrives. Credit card payments will not be accepted for invoices totaling over $5,000. Payment in full is due prior to aircraft delivery.
By signing below I agree to the terms and authorize the work listed above to be done along with the necessary material.
Signature
Signature Date:
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