Electronic Flight Bag (EFB) Application & Manual Order FormIf you would like your company's logo to be incorporated into the manuals, please email a high-quality copy of your company logo to management@blackriveraerospace.com. The following information is needed to complete your requested application. Please fill out the form as accurately and completely as possible, as this information is critical to the certification process. Note: Additional information may be needed at a future date. Note: Except for the information required for our certification project, this is for Black River Aerospace's records. It is not distributed, sold, or shared without your permission. Company & Contact Information If a line item does not pertain to your organization, please leave blacnk of mark with N/A. Will Carry / Not Carry HazMat Will Carry Hazmat Will Not Carry Hazmat Company Legal Name Any DBAs used? PBO Complete Address Main Contact Information Main Address (if different than PBO) Main Operations Base Airport (Name and ID) FAA Certificate (or Pre-Cert Number) President / CEO Director of Operations (DO) Assistant Director of Maintenance (ADOM) Chef Pilot (CP) Assistant Chief Pilot (ACP) Agent for Service (AS) Drug & Alcohol Rep EFB Administrator Other Information LAHSO Yes No Aircraft Information Aircraft Make Aircraft Model Tail Number Serial Number Aircraft Make Aircraft Model Tail Number Serial Number Aircraft Make Aircraft Model Tail Number Serial Number Aircraft Make Aircraft Model Tail Number Serial Number Notes Operator Information Operator Name (including DBAs) EFB Administrator Address City State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missisippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Virgin Islands Zip Code Phone Number Fax Number Operator Certificate Number (Part 135 Only) Email Phone Number Shipping Information Same as above Name Address City State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missisippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Virgin Islands Zip Code EFB INFORMATION EFB Make/Model Software Type Type A Type B Type C International (Non-U.S. Operators) Note: The following documents are needed for Avionics SOPs, Cockpit Reference Guide, Recommended Database Update Procedures, STC (if applicable), AFM Supplement or Section Aviation Based Programs (Check all that apply) Jeppesen Complete Flight MyRadar Cloud Topper Takeoff ForeFlight F1ightPro135 Sporty's E6B Wing X Cloud Ahoy F1tPlan GO Garmin Pilot AirNav Aerovie Flight Aware Aeroweather FlyQ FAR/AIM Windy LogTen Pro Other External Antenna(s) No Yes If yes, Antenna(s) will be used for (check all that apply): GPS Weather ADS-B In Other Power Source will be (Check all that apply): Internal Battery Only Internal Battery and Aircraft Power Outlet Internal Battery and Dedicated EFB Power Outlet in Aircraft Will EFB Be Mounted? No Yes If yes, how will it be mounted? (Check all that Apply): Kneeboard Removable by Crew Permanent (Will need a copy of the STC) Other: Please explain below Make / Model Minimum Number of EFB's in Cockpit (Does not include Backup) 1 2 Source of Backup EFB Paper Installed EFB Make/Model Repair Station Certificate Number: Contact Person Address City State Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missisippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Virgin Islands Zip Code Phone Number Fax Number Email Address Notes Company & Contact Information Send
