I, hereby for good and valuable consideration, hereby
authorize Hoosier Racing Tire Corp. to utilize my name and/or statement and/or
photographs of myself and my car in any and all publicity and sales and promotional
activities.
This race event occurred at Date Fin. Position
(All contingency Awards
must be claimed by December 15th of the same year in which the award was earned. Requests
received after this date will be denied.)
I ALSO ESTABLISHED:
PROGRAM REGISTRATION:
New track Record
Fastest Race Lap
Previously Submitted
Revised
COMPLIANCE CHECKLIST:
Hoosier Tires on all 4 wheel positions
Hoosier decals visibly displayed on both sides of car.
Hoosier Racing Tire patch sewn on drivers uniform.
Signature, TCC Scrutineer
- Impound
Date
Driver's Signature
Driver's Daytime Telephone Number
Size Requested
Compound Requested
You are responsible for the freight
charges on these tires. Please select:
UPS Ground
UPS 3-day select
UPS Blue
UPS Red
Payment:
C.O.D. (Cash or Certified Check)
Credit Card # (Visa, MC,
Discover, American Express)
Print a copy of this form off, when it is completed send it along with
the official race results to:
Hoosier Racing Tire Corp.
65465 U.S. 31
Lakeville, IN 46536
Phone: 1-574-784-3152
Fax: 1-574-784-2385
