NEW HORIZONS COMPONENTS
P.O. BOX 927
813 East Rock Island Avenue
BOYD, TEXAS 76023
Phone: 817-433-2007

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                  ORDER FORM
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ORDER NUMBER (    )                    Quantity          Total
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PLANETARY REDRIVE....($2,495.00 EACH).....(      ).....($       .   )
68" ULTRALIGHT PRO.....($475.00 EACH).....(      ).....($       .   )
68" Q-TIP HIGH HP PROP.($875.00 EACH).....(      ).....($       .   )
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Ratio........1.84 (    )
             2.18 (    )
             2.84 (    )
             3.18 (    )
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Engine:     Subaru.....EA81........(     )
                       EA82........(     )
                       EJ22........(     )
                       SVX 6 CYL...(     )
              Mazda Rotary...12A...(     )
                             13B...(     )
Other Engine: ______________.......(     )
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Thrust:     Tractor.....(      )
            Pusher......(      )
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Maximum RPM Of Engine Desired...(    )  Propeller Diameter.....(     )
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Type Of Aircraft This Unit Will Be Installed On:
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Purchaser:   Mailing Address:
             Name: _____________________________
          Address: _____________________________
 City, State, Zip: _____________________________

             Shipping Address:
             Name: _____________________________
          Address: _____________________________
 City, State, Zip: _____________________________
Phone #:(   )-(   -    ) Home: (   )-(   -    )  Work: (   )-(   -    )
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CUSTOMER RECEIPT:   TOTAL AMOUNT OR ORDER.............($      .   )
ORDER NUMBER: (    )  DOWN PAYMENT...................-($      .   ) 50%
                                                       ===========
                          BALANCE DUE:................($      .   ) C.O.D.
OFFICIAL SIGNATURE: __________________________________
                    (FOR NEW HORIZONS COMPONENTS)
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