RV-12 E-LSA GARMIN G3X AVIONICS ORDER FORM
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 increases.
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 outside
the USA.
11. Prices are subject to change without notice.
12. For European, Australian, and NZ customers, see
European order form. (GTR-200 may not be used).
13. No items may be deleted or returned from E-LSA kits.
Signature:_________________________________
Standard Avionics Kit:
• Garmin G3X Touch system: includes GDU 460 10.6” infrared touchscreen display with built-in WAAS GPS receiver,
video input and wireless Connext capability, GTX 35R transponder, GEA 24 engine monitor, GMU 22 magnetometer,
GSU 25 ADAHRS, GA 26 GPS antenna, TCW backup battery
• Garmin GTR 200 10w Com radio with stereo intercom, 3d audio, standby frequency monitoring, integrated G3X control
• ACK E-04 ELT
• Switch/fuse panels and control unit
• Wiring harnesses and mounting hardware
• NOTE: All displays come with Americas databases pre-loaded and a database refresh certificate. International customers may use the database refresh certificate to
download and install the appropriate database regions. All available databases and database bundles can be purchased through www.fly.garmin.com.
• Please contact g3xpert@garmin.com for more G3X Touch feature information or go to: www.Garmin.com/Experimental
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:
Standard Avionics Kit
$ 15,775.00
11/11/19
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 addi-
tional shipping/handling charges. For more information, contact Van's Shipping Department.
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.
TOTAL ORDER (if using fillable form leave blank) $
METHOD OF PAYMENT (if credit card, enter number/exp. date) cc#: Exp.
AMOUNT ENCLOSED (Credit cards can only be accepted for the initial 25% deposit. Balance must be paid by cash, check
money order or bank transfer.)
$
Optional Avionics Kit Totals — (From Page 2)
$
E-Mail to: kits@vansaircraft.com
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