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STC Order Form

Please print this form and fill in the required information about you and your aircraft.  Mail with a check or money order in the amount of $50.00 payable to National Aeronca Association.  Upon receipt of your STC order, we will send out a hold harmless agreement that must be signed and returned.  We will then issue the STC, the authorization and an example placard.

  Mail order to:

National Aeronca Association
304 Adda St.
Roberts, IL  60962


Please print legibly

Name: __________________________________________________________________________

Address: ________________________________________________________________________

City: _________________________________________ State ___________ ZIP ______________

Phone: ______________________________________________

Email _______________________________________________         NAA Member?      Yes           No

Aircraft Make:   ______________________________________________

Aircraft Model: _______________________________________________

Serial Number: ______________________________________________

N-Number:        ______________________________________________