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Suzuki - MXCB 04 Form (Page 1)

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Suzuki - MXCB 04 Form
ALL RM MOTORCYCLES MUST BE REGISTERED THROUGH AMERICAN SUZUKI MOTOR CORPORATION FOR CONTINGENCY PAYMENT
TWO OR MORE RACERS CANNOT SHARE ONE MOTORCYCLE. IN OTHER WORDS, ONLY ONE RACER CAN REGISTER IN THE
PROGRAM, QUALIFY FOR PAYMENT, AND RECEIVE PAYMENT PER MOTORCYCLE VIN#.
CIRCLE THE MODEL(S) YOU RACE, AND LIST THE LAST 9 DIGITS OF YOUR FRAME #
(i.e., JS1RJ16A142100007):
EXAMPLE: RM60 RM65 RM85 RM85L RM100 RM125 RM250 RM-Z250 Frame/VIN# 1 4 2 1 0 0 0 0 7
RM60 RM65 RM85 RM85L RM100 RM125 RM250 RM-Z250 Frame # __ __ __ __ __ __ __ __ __
RM60 RM65 RM85 RM85L RM100 RM125 RM250 RM-Z250 Frame # __ __ __ __ __ __ __ __ __
RM60 RM65 RM85 RM85L RM100 RM125 RM250 RM-Z250 Frame # __ __ __ __ __ __ __ __ __
Please send a new enrollment form/release when you buy additional RM models.
RACING INFORMATION
Your Suzuki Dealer______________________________________ City _______________________________ State ______
Racing Classification(s) _______________________________________________________________________________
Race Organization(s) _______________________________________________ Racing # ___________________________
SPONSORED RIDER AFFIDAVIT
(If the motorcycle is owned by another individual, the "sponsor" must complete the sponsored rider affidavit.)
I have agreed to sponsor the rider listed on this form. I am the registered owner of the vehicle and understand that no additional person(s) other than
indicated will be paid contingency from American Suzuki Motor Corporation.
Owner's Name _____________________________ Owner's Signature ___________________________ Date ____________
Address _________________________________________City ______________________State______ Zip ___________
If the motorcycle was a second party purchase, please provide a copy of the new owner registration.
I HAVE READ AND UNDERSTAND THE FOREGOING RELEASE.
Signature of Racer____________________________________________________________ Date___________________
Signature of Guardian (if racer is under 18 years)_________________________________________ Date___________________
SEND ONLY ONE FORM FOR THE CALENDAR YEAR. Remit to:
AMERICAN SUZUKI
P.O. BOX 1100
BREA, CA 92822-1100
ATTN: M/C CONTINGENCY
WE NEED DETAILS!

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