2008 Transponder Receipt of Payment

Date___________

Name__________________________________________

Address________________________________________

City_________________State___________Zip________

Phone_________________email____________________

Division________________________car #____________

Driver__________________________________________

 The above named owner / driver has paid for an AMB Tranx160 scoring transponder in the amount of:

                                  $___________.00

This price includes the transponder, transponder holder, charging system, and access to the MyLaps.com website.

Payment Received / Type:_________________________

Received By:____________________________________

Delivery of Transponder:____________By:___________

Transponder # issued:____________________________

   Mail To:

                          Steve Heckman

                           1247 Koch Rd

                     Kunkletown PA 18058