RV-12 E-LSA HDX AVIONICS ORDER FORM—AUSTRALIA / NZ
Customer Number (assigned w/ Emp kit)
Name
Mailing address
Shipping address (if different)
Day phone
e-mail
Fax
Eve phone
PLEASE READ AND SIGN BELOW
1. Kit prices are prices in effect the day order is received.
2. A 25% deposit must accompany kit orders.
3. Customer-instigated delays may result in price increas-
es.
4. Kits must be paid in full before they can be shipped.
5. $500.00 non-refundable if order is cancelled.
6. Payment in U.S. funds: check, money order, or Visa/
Mastercard/Discover.
7. Kit/plans orders must be in writing (mail, email or FAX).
8. Prices are ex-works Aurora, Oregon.
9. Freight charges are prepaid or collect, depending on
carrier.
10. Van’s Aircraft, Inc. cannot assist in certifying kits out-
side the USA.
11. Prices are subject to change without notice.
12. No items may be deleted or returned from E-LSA
kits.
Signature:_________________________________
Do not submit Credit Card information via email! If you plan to email your order form to Van’s and pay with a credit card, please omit any credit card
information from the form and either call us with your CC# or use Van’s Webstore to make a secure online payment.
Make a secure payment:
http://www.vansaircraft.com/cgi-bin/store.cgi?&browse=misc&product=payment
Standard European Skyview Avionics Kit:
Dynon SkyView HDX (ready-to-install unit includes 10" HDX Display, SV-ADAHRS-200 Attitude reference module, SV-XPNDR-262 Mode S
Transponder, SV-GPS-250 GPS receiver, SV-BAT-320 Backup battery, SV-EMS-220 Engine Instrumentation Module w/probes, SV-SYNVIS-
280 Synthetic Vision Module, SV-MAP-270 Moving Map software)
Garmin GTR-225 Com Radio (25khz spacing)and PS Engineering PM3000 stereo Intercom
ACK E-04 ELT
Switch/Fuse Panels, Control Units, Wiring Harnesses and Mounting Hardware
NOTE: International customers must purchase Jeppesen or Pocket FMS data separately.
BUILDERS OUTSIDE USA: to ship your ELT, we must program it with your airplane’s 24-bit Hex Code
(Mode S Code) provided by your country’s registration authority. Please write this code in the box at right:
Australia/New Zealand Avionics Kit
Optional Dual HDX EFIS
Includes right panel and Skyview HDX screen.
Optional Autopilot Servos
(p/n RV-12 AP SERVO KIT-SV.) (Servo wiring/mounting hardware included in fuselage kit )
Note: Skyview Autopilot/Knob modules not compatible with the RV-12 Australia/NZ configuration
14401 Keil Road NE, Aurora, Oregon, USA 97002
PHONE 503-678-6545 · FAX 503-678-6560 · www.vansaircraft.com · info@vansaircraft.com
Service Letters and Bulletins: www.vansaircraft.com/public/service.htm
TOTAL ORDER
METHOD OF PAYMENT
(if credit card, enter number/exp. Date in space below. Credit cards can only be accepted for the initial 25% deposit. Balance must be
paid by cash, check money order or bank transfer.
)
AMOUNT ENCLOSED
(25% minimum deposit required)
E-Mail to: kits@vansaircraft.com
Note to International customers: There are items in the Avionics Kit that are considered 'hazardous materials'. These items will be shipped separately
and could incur additional shipping/handling charges. For more information, contact Van's Shipping Department.
click to sign
signature
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