Work Authorization (Provide as Much Information as Possible)

Repair Location

 KBKL AOG/Other

Customer Information

Company Name (required):

Contact name:

Phone (required):

Cell Phone:

Fax:

Your Email (required):

Additional Email:

Address:

City:

State:

Zip:

Services Information

Aircraft Location (required):

Aircraft Key:
 YES NO

Keys At:

Aircraft/Engine Logbooks Provided:
 YES NO

Expected Arrival Date (required):

Arrival Time (required):

Expected Departure Date (required):

Departure Time (required):

Part Operation (required):
 91 135

Service Requested (required):

Aircraft Information

Aircraft Model (required):

Reg. No (required):

S/N:

Aircraft Total Time (required):

Aircraft Total Cycles (required):

HOBBS:

#1 Engine Model:

S/N:

TTSN:

TCSN:

#2 Engine Model:

S/N:

TTSN:

TCSN:

#3 Engine Model:

S/N:

TTSN:

TCSN:

APU Model:

S/N:

Hours:

Maintenance Tracking Program:

Warranty Programs:

Method of Payment (required):

 Wire Transfer Check Cash Credit Card

Please provide a copy of HAZMAT compliance IAW FAR 135.505(e):

I, as the aircraft registrant and/or authorized agent of the aircraft registrant of the aircraft described herein, hereby authorize CAM145, its agents and employees, to undertake and perform all repairs detailed herein, together with all necessary parts, materials and supplies required in order to effectuate same. CAM145, its agents and employees, is/are further authorized to operate said aircraft for the purpose of testing and inspection. I understand and agree that all labor, parts, materials, supplies and work are performed payable upon invoice.

I agree to the Work Authorization:

 I agree to the Work Authorization Terms and Conditions

Overtime Approval:
 YES NO

Digital Signature (required):

Date: