New Customer Information
Company Name:
Source of order: ☐ILS
☐Referral
☐Other:
Billing Address:
Shipping Address:
Phone #:
Fax #:
Email Address:
Purchasing Contact:
Freight Carrier: ☐Fed-Ex ☐UPS
☐Airborne
☐Other (please specify):
Account #:
Insurance Required: ☐Yes ☐No
☐DHL
☐Emery
☐Letter sent: (date)
Are you exempt from sales tax (CA, GA, IA, FL, NE, KS, & TX customers)? ☐No
If exempt, Copy on file? ☐No
☐Yes
Credit Limit: ☐Open: $
☐VISA
☐MC
☐AMEX
☐Yes
☐COD
***If Paying By Credit Card, please request a Credit Card Authorization form from your
salesperson
Customer type: (choose one)
☐Commercial (airlines, Commuter, Air Cargo)
☐General Aviation (Private, Corporate)
☐Original Equipment Manufacturer (OEM) ☐Fixed Based Operator & Maintenance Facility
☐Distributor
☐Defense & Military
Aircraft Type: ☐Beech
☐Avionics
☐Other
☐Engine
☐Other
Special Instructions:
Date:
Initials:
Export Compliance Approval: _______________________________ Date: ______________
(Professional Aviation Use Only)
PAAQA Form # 020
Rev.: 1