Breeze-Eastern Operational Training Customer Inquiry Form Company or Agency Name Contact Name, Title Address Phone Cell Phone Email Address Initial Inland Hoist Rescue Advanced Hoist Rescue / Water Advanced Hoist Rescue / Vessel Rappel Fast Rope Mountain/Cliff Hoist Rescue SAR Planning Hoist Maintenance Type(s) of Training Requested Water Survival/HUET Swift Water Rescue Aerial Fire – Bambi Aerial Fire – Bellytank Night Vision Short-Haul Air Medical Training Other Tactical Training What is your primary mission? Student Profile Number of Pilots Number of System Operator(s) Number of Rescue Specialist(s) Number of Other Student(s) Hoist Requirements Internal or External? Breeze Eastern Model Number Terrain of Area for Use Do you have a Helicopter Rescue Equipment Kit? Requested Dates for Training Type of Aircraft to be Used Experience Level of Students (Novice, Intermediate, Experienced) Pilot(s) System Operator(s) Rescue Specialist(s) Additional Information / Comments / Notes Breeze-Eastern Corp. Proprietary Information This document contains information that is considered privileged or business confidential in nature. Disclosure of this information without the express written approval from Breeze-Eastern Corp. is not permitted.