printableform

SUBSCRIPTION ORDER FORM

Fill out this form completely and mail (along with payment) to:

SPRINT CAR & MIDGET

PO BOX 502

PIQUA, OH 45356

Subscription information:

Length of subscription:

One year (12 issues) $18.99

Two year (24 issues) $36.00

OUTSIDE USA One year (12 issues) $36.00 US

Shipping information:

*Full Name: _______________________________________________________________

*Address: ________________________________________________________________

*City: ____________________________________________________________________

*State: ___________________________________________________________________

*Postal Code: _____________________________________________________________

*Country: ________________________________________________________________

Billing Information:

*Full Name: ______________________________________________________________

*Address: _______________________________________________________________

*City: ___________________________________________________________________

*State: __________________________________________________________________

*Postal Code: ____________________________________________________________

*Country: _______________________________________________________________

Contact Information:

*Phone Number: __________________________________________________________

E-Mail Address: __________________________________________________________

Credit Card Information (Visa or MasterCard accepted)

Credit card information is only necessary if you decide to pay with credit card:

*Card Number: ___________________________________________________________

*Expiration Date: __________________________________________________________

Please make sure all information is correct and filled out completely. Failure to do so could delay your subscription.

* = Required field