RV-12iS E-LSA KIT ORDER FORM
Customer Number (assigned w/ Emp kit)
Shipping address (if different)
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/
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
10. Van’s Aircraft, Inc. cannot assist in certifying kits outside
11. Prices are subject to change without notice.
12. Sign and return Van’s Aircraft standard Waiver and Re-
lease of Liability Agreement
13. No items may be deleted or returned from E-LSA kits.
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
FASTENER KIT Blind rivets for entire airframe. Includes Standard Aircraft Handbook. Pricing
fasteners separately allows lower overall kit price. ONE-TME purchase with first subkit.
EMPENNAGE/TAILCONE KIT All components for empennage and aft fuselage. $2,775.00
WING KIT All components for wings and flaperons. See options choices on other side.
FUSELAGE KIT All components for fuselage between firewall and rear baggage bulkhead.
Optional pre-built fuel tank. Select iS or ULS engine option.
NOTE: This Finish Kit ONLY for Fuselage kits shipped AFTER August 2017
If the FUSELAGE KIT shipped before Aug 2017 USE OTHER ORDER FORM
FINISH KIT Seat cushions, seat belts, cowling, canopy, and landing gear components. Check
interior and other option choices on separate forms
NOTE: Seat cushions ship directly from supplier. NOTE: Engine option must be selected
OPTIONS See choices on other side. Enter total cost of options. (if using fillable form leave blank)
TOTAL CRATING CHARGE (if using fillable form leave blank)
TOTAL ORDER (if using fillable form leave blank)
METHOD OF PAYMENT (if credit card,
enter number/exp. date)
AMOUNT ENCLOSED (25% minimum deposit required)
Authorization to use Credit Card for Final Payment Yes No (select one)
Customer Number of Previously Completed/Flown RV: ___________________
E-Mail to: firstname.lastname@example.org
click to sign
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