PRO STOCK DIESEL 4x4 TCLick Her Click For Form In WORD

2010 PROGRAM

ENTERPRISE ENGINE PERFORMANCE

DATE OF PULL:  __________________________________________

LOCATION OF PULL:  _______________________________________________________

FINISH POSITION AT EVENT:                    FIRST                  SECOND

                                                                      circle one of the places listed

MAKE CHECK PAYABLE TO:  ______________________________________________________

ADDRESS OF OWNER:  _______________________________________________

CITY, STATE, ZIP: ____________________________________________________

SOCIAL SECURITY NUMBER or TAX I.D.: __________________________________

I REALIZE THIS PROGRAM HAS A MAXIMUM YEARLY PAY-OUT OF $5000.00

I CERTIFY THAT I AM A CUSTOMER OF ENTERPRISE ENGINE PERFORMANCE:

CHECK ONE OF THE FOLLOWING (final determination of exact level will be made by Enterprise Engine Performance)

                  ____GOLD ($3000+)                          ____SILVER ($2000-$3000)                           ____BRONZE ($1000-$2000)

                                      SPENT AT EEP 2009-2010                                                                     SPENT AT EEP 2009-2010                                                          SPENT AT EEP 2009-2010

SIGNATURE OF OWNER/DRIVER:  _________________________________________

RETURN THIS COMPLETED AND SIGNED FORM TO:

ENTERPRISE ENGINE PERFORMANCE

9350 Ridenour Road

Thornville, OH  43076

(740) 246-6329

(all payments will be made directly by Enterprise Engine Performance)