PDRA 2025 Contingency Claim Form
Class: Top 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
*
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
Products & Services
Killin' Time Racing (KTR) - $500 Minimum Spend before Dec. 31, 2025
Rear Tires
Hoosier Racing Tire
Mickey Thompson Tires
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: