Maxxis Tires Contingency Redemption

Contingency Claim Form

Complete this form for each day that you won this contingency. All submissions will be verified with the official posted results. Any cheating will result in a permanent ban from this program.
Maxxis Tires contingency program details can be found HERE.
Driver's Information
Driver Name *

First Name Last Name
Shipping Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Email *

Confirmation Email
Event Details
NASA Region *
Track Name *
Race Date *

Month Day Year
Note: Contingency form must be submitted within 30 days of the event conclusion
Car, Class, and Tire Information
Year *
Make *
Model *
Race Class *
Tire Model *
Maxxis Tire Size *
Make sure to select a correct tire size
Race Results and Compliance
Claiming for? *

Regional Competition National Championship Endurance Race
Total Number of Classified Starters *
Note: Must match the number on the official results
Does not Meet Program Requirements *
Finishing Position *
Official Results *

Browse Files
Must be downloaded from http://timingscoring.drivenasa.com/ Cancel of
Four (4) pictures of your car showing required decals. Front, back, and sides. Pictures must be taken at the track during the event with Geo Tagging enabled. Any modifications to the original pictures will result in denial of the claim and a permanent ban from the program.
Front *
Rear *
Passenger Side *
Driver Side *
Proof of Purchase Requirements
Proof of Tire Purchase *

Browse Files

Cancel of
Order Number *
A summary of this redemption request will be emailed to you upon submission. Please allow 30 days to process your claim. For any questions regarding this program please join the conversation on our #DRIVENASA Community Forums.
Should be Empty:

Contingency Claim Form

Driver's Information

Event Details

Car, Class, and Tire Information

Race Results and Compliance

Proof of Purchase Requirements