2152 Astoria Circle # 104
Herndon, VA 20170
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e-APIS INFORMATION - AFTER SELECTING DEPARTURE OR ARRIVAL NOTIFICATION AS APPROPRIATE, ALL FIELDS ON THIS FORM ARE MANDATORY FOR U.S. CUSTOMS CLEARANCE - ANY FIELDS LEFT BLANK CONSTITUTES DENIAL OF THE CLEARANCE

Contact Name
Contact's e-mail
Contact's Business Phone Number
Contact's Cell Phone Number
Contact's Fax Number
Billing Address
Delivery Address
Name on A/C Registration
AIRCRAFT DETAILS
A/C Make and Model
A/C Registration Number
A/C Serial Number
REQUESTED PILOT QUALIFICATIONS
PIC or SIC
Type Rating RequiredYesNo
Type of Operation (i.e. Part 91, 135, 121, 125)
Insurance Minimum Time in Type
Formal Training RequiredYesNo
Max Calendar Time Permitted Since Last Training
Additional Requirements:
ROUTING INFORMATION
Departure Date From Domicile
Return Date to Domicile
Leg 1
Departure Airport (ICAO/Date) UTC
Arrival Airport (ICAO)
Number of Passengers
Number of Crew

Leg 2

Departure Airport (ICAO) / Date
Arrival Airport (ICAO)
Number of Passengers
Number of Crew
Leg 3
Departure Airport (ICAO/Date) UTC
Arrival Airport (ICAO)
Number of Passengers
Number of Crew
Leg 4
Departure Airport (ICAO/Date) UTC
Arrival Airport (ICAO)
Number of Passengers
Number of Crew

LEG 5

Departure Airport (ICAO/Date) UTC
Arrival Airport (ICAO)
Number of Passengers
Number of Crew
For Additional Legs Click Here
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