J.P. INSTRUMENTS ORDER FORM

DATE_________________	PO#___________________

CONTACT________________________________________

COMPANY________________________________________

ADDRESS_________________________________________

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CITY___________________STATE______ZIP___________

PHONE___________________________________________

FAX_____________________________________________

EMAIL____________________________________________

DROP SHIP TO: ($10 charge)

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METHOD OF SHIPPING

______FEDEX  ______UPS

____ OVERNIGHT ____ 2ND DAY ____ 3RD DAY

____ GROUND

METHOD OF PAYMENT

_______COD

_______CREDIT CARD (Fill out CC Authorization Form)

MANDATORY: MUST HAVE TO SHIP INSTRUMENT

AIRCRAFT MODEL_______________________

EXTENSION BUTTONS AVAIL UPON REQUEST

N#___________________   # OF CYL.____________

Engine Model______________Cont._____ Lyc._____

REQUIRED FOR FUEL FLOW OPTION

___INJECTED ___CARBURETOR- ___GRAVITY

IF IT’S A CARBURETOR IS IT PRESSURIZED? ___YES___ NO

DO YOU HAVE AN ENGINE DRIVEN PUMP AND/OR ELECTRIC BOOST PUMP? ___YES ___NO

GALLONS PER HOUR ON TAKE OFF____________

DO YOU HAVE AN EXISTING DIGITAL FUEL FLOW UNIT? IF YES, PROVIDE TYPE_____________________________

DO YOU HAVE TANIS HEATERS? ___YES  ___NO
(If yes, please call for options)
DO YOU HAVE A FACTORY INSTALLED CHT?

____YES ____NO
(if yes, you are encouraged to purchase a CHT M113-3/8 probe)

MAGNETOS (need for EDM-800/830 instruments)

SLICK 600 ______4000 ______6000 _____600_____

BENDIX _____20 ______1200 _____DUAL

___PRESSURIZED ___NON-PRESSURIZED

INSTRUMENTS

SINGLE ENGINE UNITS

_____EDM-700	_____EDM-730

_____EDM-800	_____EDM-830

_____EDM 740 (EXPERIMENTAL A/C)

_____EDM 700 / 800 to EDM 730 / 830 (fill out below):

WHICH FUNTIONS DO YOU HAVE ON YOUR EXISTING EDM? CHECK ALL THAT APPLY
EGT/CHT____ FUELFLOW INTEGRATED___

OAT____MAP____RPM___

OIL_____OIL PRESSURE_____USB______TIT_____CARB_____

TWIN ENGINE UNITS

EDM-760 _____ (1-3 1/8 INCH UNIT)

EDM 750	______	( 2- EDM 700 UNITS)	
EDM 850	______( 2-EDM 800 UNITS)	
EDM 751	______(2- EDM 730 UNITS)	
EDM 851	______(2- EDM 830 UNITS)	

FS-450

SINGLE ___________________

TWIN 3 1/8 DISPLAY ______________

UPGRADE & TRADE-IN

____ GEM TRADE IN FOR EDM- 700____ 760____

ADAPTER: ___STRAIGHT IN or ____90 DEGREE

____ 800 UPGRADE – DOES 700 HAVE FUEL FLOW? ____

OPTIONS (ITEMS THAT CAN BE ORDERED SEPERATELY OR WITH UNITS)

_____NEW – 3 -1/8 INCH DISPLAY FOR EDM 700 OR 800

_____ FUEL FLOW ____W/ XDUCER or ___W/O XDUCER

_____FUEL FLOW FITTINGS _____4______6_____7 QTY2

_____OIL TEMP OPTION  400505**-ADAPTER NOT INCLUDED**

_____OIL TEMP ADAPTER –SIZE_____1/4______5/8- $40

_____OAT OPTION	400510

_____TIT OPTION	M111-T

_____CARB TEMP OPTION 400128

_____IAT OPTION	M111IAT

_____CDT OPTION	M111CDT

_____RPM OPTION FOR 700(FILL OUT MAGNETO SECTION)

_____MAP SENSOR  604010

_____OIL PRESSURE OPTION

_____USB INTERGRATED in unit (with USB stick)

_____FAA 8130 FORM FOR INT”L SHIPMENTS  $100.00

_____ CHT PROBE  M-113-3/8-FOR TANIS HEATERS

_____EGT M-111

Thank you for your order.