PDRA 2025 Contingency Claim Form
Class: Pro 632
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
*
Complete Engine
Pat Musi Racing Engines
Cylinder Heads
Edelbrock
Sonny's Racing Engines
Drive Unit
Quick Drive (No Product Required, Decal Only)
Fuel Injection
Edelbrock
Fuel Pump
MagnaFuel (Proof of Purchase Required with Last 5 Years)
Intake Manifold
Edelbrock
Motorsports Insurance
Laris Motorsports Insurance
Products & Services
Killin' Time Racing (KTR) - $500 Minimum Spend before Dec. 31, 2025
Rear Tires
Goodyear Tire
Hoosier Racing Tire
Mickey Thompson Tires
Rocker Arms
JESEL
Spark Plugs
Brisk Racing Spark Plugs (Proof of Purchase Required)
Starter
Meziere Enterprises (Requires Valid Serial # for Verification)
Summit Racing Equipment
No Product Required, Decal Only
Transmission
M&M Transmission
Valve Springs
PAC Racing Springs (Requires Proof of Purchase within Last 12 Months)
Wheelie Bars
MVM by GALOT Motorsports (Carbon)
Submit
Should be Empty: