PIT PAD ORDER FORM

 

Driver’s Name:___________________________________________________

 

Car Number:_____________________________________________________

 

Division:________________________________________________________

 

Pit Pad Number in 2011:___________________________________________

 

Pit Pad Number requested for 2012:__________________________________

 

Pit Pad Fee for 2012 - $113 taxes included

 

Payment Options:

1.  Cheque made payable to Barrie Speedway Inc.

2.  Cash

3.  Credit Card:  (Circle One)                   Mastercard                                    Visa                            

Card Number:______________________________________________________

 

Name as it appears on card:___________________________________________

 

Expiration Date:_________________  Security Code:______________________

 

Signature:_________________________________________________________

 

Amount charged on card:_____________________________________________

 

 

 

HST Reg No. 820472603RT0001



255 MUSKOKA RD. NORTH