AircraftPortal.com Piston Powered Aircraft
Photo Enhanced Advertisement Submission Form.

Payment methods and totals are listed at the end of this
form. 
Important Note...
Please print this form and fill in the required information. 
Please print clearly for all responses. Mail/fax using the
following information.

AircraftPortal.com
3336 Associates Drive
Burton, Michigan 48529-1302
810-232-9979 Phone
810-232-7177 Fax
866-232-9979 Toll Free Phone
866-232-7177 Toll Free Fax

Required Information (*)

- Aircraft Company/Owner Information
                        First Name (*): _______________________________
                         Last Name (*): _______________________________
                          Company Name: _______________________________
                           Address (*): _______________________________
                                        _______________________________
                              City (*): _______________________________
                    State/Location (*): _______________________________
                               Zip (*): _______________________________
                Phone Number - Day (*): _______________________________
               Phone Number - Evenings: _______________________________
                 Optional Phone Number: _______________________________
                            Fax Number: _______________________________
                       Cellular Number: _______________________________
                          Pager Number: _______________________________
                          
                  E-mail Address - One: _______________________________
                  
                  E-mail Address - Two: _______________________________
                  
       (Home Page Link is required for
                External Link Address)
                        Home Page Link: _______________________________

- Aircraft Overview and Summary Data
                 Aircraft Manufacturer
               and Type/Description(*): _______________________________
                         Aircraft Year: _______________________________                             
          Aircraft Registration Number: _______________________________
                Aircraft Serial Number: _______________________________
                   Aircraft Total Time: _______________________________
                  Location of Aircraft: _______________________________
                          Asking Price: _______________________________
                Last Annual Inspection: _______________________________

 - Aircraft Engine and Propeller Times
Engine Total Time (TT) - Left Outboard: _______________________________
                          Left Inboard: _______________________________
  Right Inboard/Single Engine Aircraft: _______________________________
                        Right Outboard: _______________________________
Engine Total Time STOH - Left Outboard: _______________________________
                          Left Inboard: _______________________________
  Right Inboard/Single Engine Aircraft: _______________________________
                        Right Outboard: _______________________________                  
Engine Total Time SMOH - Left Outboard: _______________________________
                          Left Inboard: _______________________________
  Right Inboard/Single Engine Aircraft: _______________________________
                        Right Outboard: _______________________________
   Propeller Time SPOH - Left Outboard: _______________________________
                          Left Inboard: _______________________________
  Right Inboard/Single Engine Aircraft: _______________________________
                        Right Outboard: _______________________________

- Exterior/Interior Colors/Appointments
                        Exterior Color: _______________________________
                     Exterior Trim One: _______________________________
                     Exterior Trim Two: _______________________________
                   Exterior Trim Three: _______________________________
                    Exterior Other One: _______________________________
                    Exterior Other Two: _______________________________			
                     Interior Overview: _______________________________
                    Interior Color One: _______________________________
                    Interior Color Two: _______________________________
                  Interior Color Three: _______________________________
                    Interior Other One: _______________________________
                    Interior Other Two: _______________________________

- Avionics
               Avionics Overview - One: _______________________________
               Avionics Overview - Two: _______________________________
                           Audio Panel: _______________________________
                             Autopilot: _______________________________
                            Nav/Comm 1: _______________________________
                            Nav/Comm 2: _______________________________
                    Weather Protection: _______________________________
                                   GPS: _______________________________
                           Transponder: _______________________________
                         Description 1: _______________________________
                         Description 2: _______________________________
                         Description 3: _______________________________
                         Description 4: _______________________________
                         Description 5: _______________________________
- Optional Equipment and Accessories
                           Option - #1:  _______________________________
                           Option - #2:  _______________________________
			   Option - #3:  _______________________________
			   Option - #4:  _______________________________
			   Option - #5:  _______________________________	
		           Option - #6:  _______________________________
                           Option - #7:  _______________________________
                           Option - #8:  _______________________________
                           Option - #9:  _______________________________
                           Option - #10: _______________________________
                           Option - #11: _______________________________
                           Option - #12: _______________________________
- Notes of Interest (Maximum length is 725 characters - includes all
                     characters and spaces).
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
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Aircraft Highlights and Feature Color (Circle one)
                   1.)Green   2.)Blue      3.)Yellow
Background/Display (Circle one)
                   1.)Clouds  2.)IFR Chart 3.)VFR Chart
Please mail any required photo(s)(feature up to 6) to the address above.
Clearly mark on the back of each photo your name and aircraft 
registration number. All photo(s) become the property of 
AircraftPortal.com unless a self addressed stamped envelope is included
for return.

- Any additional information we should have to process this ad?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________


Sixty (60) Day Run Time...

Photo Enhanced Piston Powered Advertisement:                    $ 14.95

                                                               ________
                                            Total Enclosed     $  
                                            
- Payment Method (please mark the appropriate selection)

      Check: _____ (see note below)

Money Order: _____      
 
 MasterCard: _____ Card Number: ______________________ Exp. Date: _____
 
                        Name on Card: _________________________________
 
 Credit Card Authorization Signature: _________________________________
 (Please charge my credit card the
 total listed above)
 
        Visa: _____ Card Number: ______________________ Exp. Date: _____
        
                        Name on Card: _________________________________
 
 Credit Card Authorization Signature: _________________________________
 (Please charge my credit card the
  total listed above)
       
Important Note:

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