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	Country

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 Date Picker Icon
Car, Class, and Tire Information
Year *
Make *
Model *
Race Class *
Tire Model *
Maxxis Tire Size *
Make sure to select a correct tire size
Maxxis Victra R19 sizes can be found HERE.
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(Regional) *
Finishing Position(National Championships) *
Finishing Position(Endurance) *
Number of Tires Won
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 *
Registration and Proof of Purchase requirements.
Did you Register for the MAXXIS Contingency Program this Year? *

Yes No
Register Here:

http://maxxisrc1.com/contingency/
Did you Submit a Proof of Tires Purchase? *

Yes No
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 community forums HERE.
Should be Empty:

Contingency Claim Form

Driver's Information

Event Details

Car, Class, and Tire Information

Race Results and Compliance

Registration and Proof of Purchase requirements.