Hsr Amb Transponder Rental Form printable pdf download

HSR AMB Transponder Rental Form

Car Owner/Driver Information

Event rental is to be used ____________________________________________________________________

Car Owner ____________________________ Driver

____________________________

(If different than owner)

Address _______________________________________ City, State Zip ______________________________

Cell Phone @ track _________________________________ Phone: _______________________________

Email _____________________________________________________________________

Car Information - Please use one form for each transponder purchase and/or rental.

Car Year _____________ Make/Model _______________________________________________________

Color _________________ GROUP__________________ Car # (Usual) ______________

FOR OFFICE USE ONLY - Transponder # assigned to above: ________________________________

Date & Time Returned: _________________________________________

Fees

Rental (CASH OR CHECK ONLY) …………………………………….…………….$ 50.00________

Rental (CREDIT CARD ONLY) …………………………………….…………..…….$ 60.00 ________

Rental Deposit ................................................................................................................. $ 500.00 ________

Total Enclosed: ………………………………………………………………$

_________

Method of Payment:

Check # ______ (Payable to Janet Harhay)

CASH ___________

Credit Card # ______________________________

Expiration Date _________ PIN ____ (3 digits on back of card)

Name on Card _____________________________

Signature _________________________________

Note: HSR, SVRA, PCA, BMWCCA, VDCA, NASA, PBOC and SCCA are currently using the same system. If you

already have a transponder from racing with one of these organizations, please contact the office to provide your

transponder number. You will not need to rent a unit.

As a condition of rental, the Owner/Driver certifies understanding of the following: It will be the responsibility of the renter to return

the transponder(s) in good condition in order to receive the deposit back. Renters who fail to return transponders by the close of

the event will forfeit $50 of their deposit. If the transponder is returned at a later date, the driver will receive a $300 credit.

Renters returning damaged transponders shall forfeit the entire deposit for replacement of said damaged transponder.

Signature ____________________________________________ Date ____________________

***Note: Make checks payable to Janet Harhay. Bring this form to track or mail to Janet Harhay, 2321Woodbend

Circle, New Port Richey, FL 34655

Hsr Amb Transponder Rental Form