South Boston Speedway Driver Information Packet

SOUTH BOSTON SPEEDWAY DRIVER INFO PACKET

Any driver competing at South Boston Speedway must complete a driver information packet in order to be paid any winnings.
Driver Information

General driver information.
Full Name*

First NameMiddle NameLast Name
Nickname
Social Security Number (used for accounting system & taxes)*
Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address (if different than physical)

Mailing Address

Mailing Address Line 2

CityState

Zip Code
Date of Birth*
Phone*
Email*
Transponder Number*
Radio Frequency (if applicable)*
Car Number*
Car Year*
Car Make & Model*
Division*
Are You Declaring as a Rookie in Your Division This Year?*

YesNo
Sponsor(s) - please list all & note primary*

Driver Health Information

For our safety team and medical staff in the event it is needed.
Allergies*
Medications*
Other important medical history & information*

Financial Information
Please detail who should be paid all monies issued (purse and other awards).

An IRS Form W-9 is also required. The form and an area to upload it is provided below.

The below financial information section and the W-9 are required before any purse and/or other award monies will be paid.
Make checks payable to*
Mailing Address for Checks (if different than driver's info listed previously)

Street Address

Street Address Line 2

CityState

Zip Code
Federal Tax ID or Social Security Number of Individual Getting Paid (if different than driver's info listed previously)
An IRS W-9 Form is required. Please download the form below using the downward-facing arrow and then upload it in the area provided below. You can digitally complete all fields except signing. Signature is required.
Upload IRS Form W-9 for Individual Getting Paid*

An IRS W-9 form is still required for tax reporting. Please upload a completed/signed IRS W-9 form above.
Cancelof
Driver Signature*

Clear
By signing, certify that all information is accurate to the best of my knowledge.
Should be Empty:

Driver Information