RV-12 E-LSA POWERPLANT KIT 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
•Kit prices are prices in effect the day order is received.
•Prices are subject to change without notice.
•A 25% deposit must accompany kit orders.
•Customer-instigated delays may result in price increases.
•Kits must be paid in full before they can be shipped.
•$500.00 non-refundable if order is cancelled.
•Payment in U.S. funds: check, money order, or bank trans-
fer. We accept Visa/Mastercard/Discover for deposit only.
•Kit orders must be in writing (mail, FAX, e-mail).
•Prices are ex-works Aurora, Oregon.
•Freight charges are prepaid or collect, depending on carri-
er.
•Van’s Aircraft, Inc. cannot assist in certifying kits.
•No items may be deleted or returned from E-LSA kits.
Signature:_____________________________
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.
RV-12 Powerplant Kit includes Rotax 912ULS engine, hoses, oil cooler, radiator, wiring harness, engine mount, hard-
ware, control cables, battery, documentation, as well as other items to form a complete firewall forward kit. Select a 2 or 3
-blade Sensenich ground adjustable propeller and spinner. NOTE: For FUSELAGE kits shipped prior to August 2017
POWERPLANT KIT (Due to the competitive nature of items contained in Powerplant Kits, credit cards can only be
accepted for the initial 25% deposit. At least 75% of the Powerplant Kit payment MUST be paid by cash, check, money order
or bank transfer.)
1/28/20
$28,175.00
TOTAL CRATING CHARGE standard $90.00
TOTAL ORDER
METHOD OF PAYMENT (if credit card, enter number/exp. date)
AMOUNT ENCLOSED (25% minimum deposit required)
E-Mail to: kits@vansaircraft.com
Sensenich 2-blade, ground-adjustable propeller and spinner, related hardware
12 PROP KIT-2 BLADE SENS
Sensenich 3-blade, ground-adjustable propeller and spinner, related hardware
12 PROP KIT-3 BLADE SENS
$2,150.00
$2,825.00
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