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Repair/Return Form

Customer Name_______________________________________________Date________________

Address_______________________________________________________City______________________State_________Zip_________

Country______________ Phone # _________________Cell #____________Email__________________________

Items in box:

DA 50R#_________________DA100 #___________________DA 150#_____________

Ignition: Single serial # _________________ Ignition Twin Serial #__________________

Prop Bolts?-__________________________

Prop washer?_________________________

Muffler(s)? ___________________________

Standoffs ____________________________

Other Items?__________________________

Prop used: _________________ Approx # of hours used, or fuel consumed _______________

Oil used: ______________________ Gas to oil ratio________________________

Exhaust system:. _____________________________

REASON FOR RETURN?

__________________________________________________________________________________________________

DESERT AIRCRAFT

1815 S. Research Loop Tucson,AZ 85710

Ph: 5207220607 Fax: 5207225622 desertaircraft@theriver.com