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| BURL'S AIRCRAFT REBUILD, LLC P.O. Box 671487 * Chugiak, Alaska 99567-1487 ~ Phone: (907) 688-3715 E-Mail: burl@biginalaska.com | 
| Name:_______________________________________________________________ Company Name:______________________________________________________ Address:_____________________________________________________________ City:___________________State:______Country:_______Zip Code:____________ Phone:_________________Fax:________________E-Mail:_____________________ Make and Model of Aircraft:_____________________________________________ Type of Tailwheel (REQUIRED):___________________________________________ | 
| Note: Ski is not approved with any tailwheel locking device. | 
| Ski Model | Tailwheel Installed on your Aircraft | Price | Qty | Total | 
| 3200-8-23 | 3200 series Scott, 8" tire, flat tail spring mount | $ | ||
| 3400-8-23 | 3400 series Scott, 8" tire, round tail spring mount | 
 | $ | |
| 3400-10-23 | 3400 series Scott, 10" tire, round tail spring mount | 
 | $ | |
| 3400-10-23S | 3400 series Scott, 10" tire, flat tail spring mount | 
 | $ | |
| AB3200-8-23 | 3200 Series 8" Alaska Bushwheel (Scott replacement (3200-8-23 WILL NOT FIT) | 
 | $ | |
| AB3400-8-23 | 3400 Series 8" Alaska Bushwheel (Scott replacement (3400-8-23 WILL NOT FIT) | 
 | $ | |
| 3400-10-23AB | 3400 Series 10" Alaska Bushwheel (Scott replacement (3400-8-23 WILL NOT FIT) | 
 | $ | |
| 3400-10-23BBW | Fits all ABI3200B and ABI3400B Tailwheels | |||
| Shipping & Handling Charges All orders will be shipped via USPS Priority Mail inless otherwise specified. Orders out of the U.S.: contact us for export application | Subtotal | $ | ||
| S & H (see left) | $ | |||
| Total: | $ | |||
| PAYMENT TERMS: U.S. Funds Mastercard:___ Visa___ Certified Check or Money Order Enclosed____ | 
| Card Number:_________________________________________________________ | 
| Expiration Date:_______________________________________________________ | 
| Cardholder Name:_____________________________________________________ | 
| Cardholder Signature:__________________________________________________ | 
| V Code:______________________________________________________________ | 
| Please send completed form to the address above. |