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2024 NY6A 600 Sprint Tour License (Membership) Form
25
BONUS POINTS & $75 Fee if BEFORE APRIL 1st
NO
Bonus Points & $100 Fee AFTER APRIL 1st
Mail Payment to US6A Inc. 3005 Niagara Falls Blvd. Amherst, NY 14228
(I
n order to get bonus & $75 fee; payment must be mailed and postmarked by March 31st)
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* Indicates required question
Email
*
Your email
Name of Driver's (Full Legal Name)
*
Your answer
Driver's Nick Name
Your answer
Car Number
*
Your answer
Driver's Phone Number (with area code)
*
Your answer
Driver's Address
(Street Address, City, State, Zip Code)
*
Your answer
Driver's Email Address
*
Your answer
Driver or Car Owner's SSN or EIN # (whom is receiving payout funds)
NY6A requires a W9 on file
(W9 form can be found at
http://www.ny6atour.com/
)
PLEASE MAIL THE W9 WITH YOUR PAYMENT.
*
I agree to print, complete & mail the W9 with my payment
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