DRIVER INFORMATION FORM

CAR#:______________________CLASS:______________________COLOR:_______________

DRIVER’S NAME:________________________________________________________

HOMETOWN:___________________________________________________

ENGINE:______________________BODY:___________________________

DRIVERS PHONE:_______________________________________________________

SPONSORS:

 Notice: the section below must be completed for the purpose of 1099 requirements. The person or entity listed below will receive the 1099.

NAME AS FILED:________________________________________________________

ADDRESS:_____________________________________________________

SS# OR TAX I.D.#:______________________PHONE:___________________________

DRIVERS NAME:_______________________________________________________

ADDRESS:____________________________________________________

CAR # AND CLASS:_______________________________________________________

 PLEASE COMPLETE AND TURN IN TO THE OFFICE. THERE WILL BE NO PAYOFF IF TAX INFO IS NOT COMPLETE.