Owner Information

Name (First and Last):

Street Address:

City:

State:

Zip:

Cell phone:

Daytime Phone:

Email address:
Please note: A full email address looks something like this:

(This is required)
JohnJones@aol.com or Janie133@prodigy.net.

Aircraft Information (Be as specific as possible)

Aircraft Make:

Model Description:

Aircraft Year:

Total Time:

Hours since overhaul of engine(s):

Hours since overhaul of propeller(s):

Registration (Tail) Number:

Serial Number:

Equipment List:

Other Options or added equipment:

Status Of Annual Inspection:

Is the aircraft airworthy?

Is there any damage (accident) history? Please give details and severity of damage:

When was the aircraft last flown?

If the annual inspection is out of date, do you feel the aircraft could get a FERRY PERMIT?
Please explain:

What is the overall condition of the tires?

Condition of Exterior and Interior:

(Please rate each from 1 to 10. 10 being new.)

Exterior 1 2 3 4 5 6 7 8 9 10 Please Select Interior 1 2 3 4 5 6 7 8 9 10 Please Select

(A typical scuffed up faded paint and interior would be a 5 for each.)

Location and Special Instructions

Location (exact address) of aircraft:

Phone number & name of any contact person at location:

Thank you for your participation in Donate Aircraft to Charity.

We will process your form and then you will be contacted very soon by email.

Please stay alert for email responses. If for some reason we are not able to pick up in your state we will notify you.