AURORA AVIATION, LLC
PILOT / CUSTOMER INFO SHEET

 

Name _______________________________________   /   Company   ___________________________
           Last,  First, Middle

 

Physical Address   ______________________________________
                                ______________________________________
                                ______________________________________
         
Mailing Address    ______________________________________
                                ______________________________________
                                ______________________________________

Phone #    ________________   ________________   _______________   _______________
                 Home                          Cell                             Office                        Fax                  

Email  -    _________________________________

Credit Card Account #   ________________________________   Exp.  ____/______   CCV   _________
nbsp;                                                                                                              Mo / Year

Drivers Lic #  ___________________________  State  ________   Exp.  ____/______
                                                                                                                         Mo / Year

 

Pilot Info :    DOB  _________________      Certificate #  _____________________________
                                Mo / Day / Year

                      BFR   _________________      Medical Date __________________   Class  ____________
                                 Mo / Day / Year                                       Mo / Day / Year

 

Ratings / Endorsements :  Check all that apply

Student   ______     Commercial   ______      ATP   ______   Multi Engine   ______   Complex   ______
Private    ______     Instrument     ______     CFI/I  ______   Tail Wheel       ______   Hi Perf      ______

 

 

 

         By my signature below I attest that all the information provided on this sheet is true to the best of my knowledge.
                                 
                                    Signature ____________________________________   Date  ________________