PDRA 2024 Contingency Claim Form
Class: Pro Jr. Dragster
Car Number
*
Competition Car Number
Driver Name
*
First Name
Last Name
Payee Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-Mail
*
example@example.com
Phone Number
*
Federal ID / SS Number
*
Battery
Braille Lithium Battery
Chassis
Half Scale Dragsters
Data Logger
Computech Systems (Datamaxx)
Fuel Pump
MagnaFuel (Proof of Purchase Required within Last 5 Years)
Motorsports Insurance
Laris Motorsports Insurance
Oil
Maxima Racing Oils (Buy-In $300 through Steven Boone Racing)
Rear Tires
Hoosier Racing Tire
Mickey Thompson Tires
Seat Belts
Stroud Safety
Spark Plugs
Brisk Racing Spark Plugs (Proof of Purchase Required)
Summit Racing Equipment
No Product Required, Decal Only
Weather Station
Computech Systems (RaceAir Cloud)
Submit
Should be Empty: