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BURL'S AIRCRAFT, LLC
P.O. Box 671487 * Chugiak, Alaska 99567-1487 ~ Phone: (907) 688-3715 * Fax: (907) 688-5031
E-Mail: burl@biginalaska.com
Name:_______________________________________________________________

Company Name:______________________________________________________

Address:_____________________________________________________________

City:___________________State:______Country:_______Zip Code:____________

Phone:_________________Fax:________________E-Mail:_____________________

Make and Model of Aircraft:_____________________________________________

PARTS ORDER FORM
Qty Part Number Description Price
       
       
       
       
       
       
       
       
Shipping & Handling Charges
All orders will be shipped via USPS Priority Mail unless otherwise specified.
Subtotal $
S & H (see left) $
Total: $
PAYMENT TERMS: U.S. Funds
Mastercard:___            Visa___             Certified Check or Money Order Enclosed____
Card Number:_________________________________________________________    CVC Number:___________________________
Expiration Date:_______________________________________________________
Cardholder Name:_____________________________________________________
Cardholder Signature:__________________________________________________

Please send or fax completed form to the address above.