Shipping Address
975 Cobb Place Blvd NW
Suite 210
Kennesaw, GA 30144 
PLEASE FILL OUT THIS PAGE AND INCLUDE WITH YOUR SHIPMENT

I am confirming, to the best of my knowledge, the part(s) being sent to ASEI is fabricated from 6061 Aluminum, and requested to be repaired in accordance with applicable ASE repair procedure(s) or processes: Name

Signature Date

Part 121 & 135 operators: Please provide instructions on your PO and/or on this form to repair your part in accordance with ASE repair procedures or processes as applicable to ensure your continued airworthiness maintenance program (camp) is satisfied. Please include a copy of the part # and fig. from your IPL or AMM, if possible.

Customer Information: P.O. #   Billing Address (If Different) 
                                                     City 
                                                 State 
                                                       Zip 
Return Shipping Address                            Check Box for Insured Return Shipping 
              (Value will be the Repair Cost)
                                   
                   Return Shipping Service
                 Ground              2 Day 
                    Next Day