CUSTOMER PARTS REQUEST / ORDER FORM
Aircraft Model:
Serial No:
Telephone:
Name:
FAX:
Mailing Address:
Shipping Address:
Part Number
Part Description
Quantity
Price
Packaging / shipping / documentation cost
TOTAL
Requested Shipping Method: UPS FedEx Standard Mail Other ______
Your Courier Shipping Number: _____________ Your Federal Tax I.D. Number: ___________
Visa Card Number: ___________________________ Exp. Date ________
Ship above items immediately and bill my credit card.
Fax a quote - for the above items only
Name of Visa card holder:
Signature authorizing all of the above:
Date:
Complete this form and FAX or mail this form to AMD when ordering parts.
AMD – 441 Airport Road, Eastman GA 31023 USA
Tel: 478-374-2759 Fax: 478-374-2793
FORM 2
July 09
