2152 Astoria Circle # 104
Herndon, VA 20170
Fax 703 657-0340

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

Customer Name
Primary 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
PERSON RESPONSIBLE FOR MAINTENANCE OPERATIONS
Name
Title
Business Phone Number
Cell Phone Number
Fax Number
E-Mail Address
Delivery Address
AIRCRAFT DETAILS
A/C Make and Model
A/C Year of Manufacture
A/C Registration Number
A/C Serial Number
A/C Base Color and Trim Color
MTOGW (lbs.)
Zero Fuel Weight (lbs.)
Basic Empty Weight BEW/BOW (lbs.)
Engine Type and Dash Number
A/C Base of Operations
Maximum Fuel in Pounds
RVSMYes    No
MAINTENANCE DETAILS
Airworthiness Directive's (AD's) Not Complied With
Inspections Past Due
Inspections Due
RVSM CERTIFICATION INFORMATION
Was A/C Manufactured RVSM Compliant?    Yes    No    if no,
RVSM Completed by:
Vendor or Maintenance Facility
Contact Name
Contact Cell Phone Number
Business Phone Number
Fax Number
Contact E-Mail Address
Facility Website or E-Mail Address
Mailing Address
Date Completed
Comments:
MAINTENANCE OF RVSM EQUIPMENT
Maintenance Facility
Contact Name
Contact Cell Phone Number
Business Phone Number
Fax Number
Contact E-Mail Address
Facility Website or E-Mail Address
Mailing Address
Certified Repair Station Number

RVSM/MNPS EQUIPMENT INFORMATION and
LONG RANGE NAVIGATION AND COMMUNICATIONS SYSTEMS

Qty.

Type of Equipment

Manufacturer

Part No.

Autopilot
Primary Altimetry (Altimeters and/or EFIS)
Air Data Computers
Altitude Alerter
Transponder
TCAS
EGPWS/GPWS
GPS
INS
IRU/IRS
LORAN
VHF  8.33 KhzYesNo
HF
SATCOM
SELCAL      CODE: 

DETAILS OF WORK TO BE PERFORMED:

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