CAROLINA MOTORSPORTS PARK, INC.

Mailing Addr: PO Box 366, Kershaw, SC 29067 / Shipping Addr: 3662 Kershaw Hwy, Kershaw, SC 29067

803-475-2448 / Fax# 803-475-3303

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DAY GARAGES REGISTRATION FORM*

DATES REQUESTED_____________________________ #of GARAGES___________

NAME:_______________________________________________

STREET: ___________________________________________________

CITY:_______________________________ STATE:_______________

ZIP CODE:_____________

PHONE: (DAY)____________________________ (NIGHT):__________________ (CELL):____________________________(FAX#):_________________________

CAR/BIKE NO# _______ COLOR ______________ MAKE ___________

CREDIT CARD (VISA/MC ONLY) NAME OF CARD: ______________________

CARD#: ____________________________________ CVV**#_________________

EXP DATE: ____________________

BILLING ADDRESS: _____________________________________________________________

AMOUNT PAID $_____________ CHECK #_______________

Please make check payable to: CAROLINA MOTORSPORTS PARK, Inc.

*Garages must be paid in full on the day that the reservation is made

** 3 Digit Security Code on the back on your credit card