BIO RACE FUEL Pre-Order Form – Summernats 2015 Please FAX or EMAIL your completed form PHONE: 1800 3842 665 FAX: 1300 543 764 EMAIL: [email protected] Web: www.bioracefuel.com.au Entrant Number: _______________ mobile: _____________________ PREPAID Entrant Name: ____________________________ Email: ______________________________________ PAY AT EVENT tick FUEL TYPE METHANOL Race 98 (e98 ethanol) Race 85 (e85 ethanol) Premium Unleaded 98 105 unleaded 110 unleaded PREPAID AT EVENT $1.30/l $2.20/l $2.20/l $n/a $n/a $n/a $1.75/l $2.50/l $2.50/l $1.75/l $4.00/l $4.50/l LITRES Must be pre-paid Other fuels TOTAL $ N/A Bio race fuel will contact you regarding your price Manufacturer and grade will be required tick UPPER CYLINDER LUBE(473ml BOTTLES) vp m2 additive vp m2 additive strawberry scented Price (must be prepaid) Bottles rqd TOTAL $ $27 ea. $37 ea. TOTAL OF PURCHASE: ADD BOTH FUEL AND ADDITIVES TOGETHER FOR TOTAL PAYMENT TOTAL $ DEADLINES: PREPAID CUT OFF 12th DEC 2014, OTHER FUELS AND ADDITIVES 5th DEC 2014 Payment options: Cash or Card at the EVENT, PREPAID FUEL CHARGED UPON ORDERING CREDIT CARD NUMBER: EXPIRY (M / Y): ____ ____ ____ ____ ___ __ /__ AUTH. NO. (LAST 3 DIGITS ON BACK) NAME ON CARD: NB: Your signature also confirms you are authorised to use this card.
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