Service Release Form

Contact Information

Customer First Name:

Customer Last Name:

Company (Optional):

Phone:

Email:

Address:

City:

State:

Postal Code:

Aircraft Information

Tail #:

Make/Model:

Date Aircraft Dropped Off:

Additional Information

Did you leave your logbooks?

Yes

No

Did you leave your aircraft keys?

Yes

No

Did you leave your POH?

Yes

No

Did you leave a copy of the current weight and balance?

Yes

No

Requested Work

Comments/Squawks - Please be as detailed as possible:

Date Aircraft Requested: *While it is not guaranteed, we will do our best to accomodate the date requested.

Quote/Sales Order # (if applicable):

Supporting Documents

Select File to Upload (Only image files will be accepted):

Shipping (if applicable)

It is our policy is to insure all shipments for full replacement value. If you choose to decline insurance on any shipments made by SAI you accept and assume full responsibility for any loss or damage to any shipment or package once it has left our facility. SAI will not be responsible for any merchandise or equipment regardless of the condition it is received in, nor for any missing merchandise or equipment that may be lost during transit.

Check the following box only if you do NOT want us to insure your shipments:
I have read and understand the above statements, and choose to waive insurance on shipments from Sarasota Avionics.

Pilot Authorization

I authorize Sarasota Avionics to fly the above mentioned aircraft as needed.

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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