Confidential Survey for StrongMobile Requirements Database You can copy and paste this form into a text file, fill in as much as you care to, then e-mail it to RichStrong@aol.com, with Subject: Survey, or USPS to: R. A. Strong, 7514 Belle Plain Drive, Dayton OH 45424-3229 Name:________________________________ E-Mail:___________________________ Address1: ________________________ Address2: _____________________________ ST: ____ ZIP: ______ Phone: ___________ Ext. ____ FAX #: ___________Ext. ____ Aero Rating(s): _____________________ PIC Time: _____ Gender: ____ Age: ____ Please describe activities that you would use your StrongMobile for: Organizational:____________________________ Personal:____________________________ Title: ___________ Organization Name: ________________________ NAIC: _______ How many StrongMobiles would you use in your organizational or team fleet?: _____ How many miles you'll drive per year for: a. business: ____,000 and b. personal: ____,000 How many flight hours per year for: a. business; _______ and b. personal; _______ If you would co-own with others, then enter the total for all. How many?: _____ Would you join a Team?: Yes ___ No ___ Hours you would spend building: ________ The basic Dragon will have SRS, A/C, power steering and brakes, ABS, automatic transaxle, fixed-pitch fan with clutch, run-flat tires, & speed control. How much would you pay for a 2-seat ______ or 4-seat _______ StrongMobile? a. kit: $_____,000 b. factory-built: $______,000 c. rent/lease/flt.hr: $_____ STOL version: $_____,000 4-place version: $_____ ,000 If you want more for the items listed, then enter how much more you want/need and how much more you would pay for it. Over 10 years service life? Years; ____ Pay: $____,000 Over 10,000 Flight hours; ____ ,000 Pay:$___,000 Over 120,000 Road Miles; _____,000 Pay:$____,000 Over 195 lb. Pilot & passenger(s) weight?: _____ lbs. Pay:$____,000 Over 66 lb. per occupant baggage/cargo weight?: ______ lbs. Pay:$____,000 Over 420 nm Range: ____nm Pay:$___,000 Over 140KTAS Cruise: ____kts Pay:$__,000 Over 10,000 ft Cruise Ceiling: ____,000 ft Pay:$____,000 Anti/De-icing System: $____k Retractable wheels? Pay:$___,000 Autopilot: Pay:$__,000 Controllable-pitch fan: Pay:$___,000 Rotary engine: $___,000 Turbocharger- Pay $___,000 Cabin Pressurization -$___,000 Questions and comments: _______________________________________________ _____________________________________________________________________ _____________________________________________________________________