Split Second Timing, Inc.
READ THIS BEFORE PROCEEDING!!!!

The information you will enter below is the information that will be stored in the ChampionChip worldwide database. This means that if you are purchasing a ChampionChip for someone, besides yourself, you must know certain biographical information about the person who will be using the ChampionChip. The required information is on the form below.

THIS IS NOT THE CREDIT CARD PROCESSING FORM.

Every field must be filled in about the USER of the ChampionChip or it will delay the shipping process. Once you submit the form please click submit and wait until the user information has been uploaded to our database. Once you recieve confirmation that the user information has been uploaded successfully you may proceed to our secure online credit card processing form.
Customer Data:
Last Name:
First Name:
Middle Initial:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Country:
Gender:
Birth Date:
Age:
Home Phone Number:  (Use this format 5556667777 without hyphens)
Work Phone Number:  (Use this format 5556667777 without hyphens)
E-Mail Address:
(Use this format johndoe@email.com)