TEAM WIX SPONSORSHIP APPLICATION

RACE TEAM INFORMATION:

Race Team Name *

Address *

City *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone *

PARTICIPATING AUTO PARTS STORE INFORMATION:

Auto Parts Store Name *

Address *

City *

State/Province *

ZIP/Postal Code *

Country *

WIX District Manager *

Email Address *

PRODUCT INFORMATION:

Please provide the WIX Racing Filter part numbers you will be using.

Racing Oil Filter #

Quantity

Racing Air Filter #

Quantity

Racing Fuel Filter #

Quantity

Total Amount of Invoice ($) *

Rebate Total (Invoice Total x 20%) *

(Note: Filter quantities are limited to 3 cases of oil, 3 cases of air and 3 cases of fuel)

E-signature *

Date *

*Indicates required fields