Ministry Name: ______________________________________ Date:___________
USA Contact:_____________________
Address_______________________________________________________________
Phone__________________________
Cell____________________________
Email___________________________
Overseas contact __________________
Address_______________________________________________________________
Phone__________________________
Cell____________________________
Email___________________________
Describe your ministry: __________________________________________________
______________________________________________________________________
Primary Application: (circle one)
medical farm construction water school/orphanage business
Secondary Application: (circle one)
medical farm construction water school/orphanage business
Describe how you will use the BUV: _________________________________________
______________________________________________________________________
Who is responsible for maintenance and training new drivers?____________________
Circle or underline the type(s) of terrain that the BUV will be used on:
Rocky Hills Mountains Sand Mud Other (describe)
_______________________________________________________________________
Do you have a rainy season? ________ If so, what months? _____________________
Average length of your trips: (circle) 0-1 km 1-5 km 5+ km
How do you currently transport loads: _______________________________________
_______________________________________________________________________
Steepest Slope that BUV will be used on: ____% Grade = (Rise/Run) x 100%Typical speed of cars on roads where BUV will be used: _________
Is your ministry (or another) able to include the BUV in their ocean container? (y/n) ___
When does it depart USA?_________ Where does it load in the USA?___________
How much is your ministry able to pay? $500 $1000 $2000 $3000
(donors like to see strong commitment from the recipient organization).
Do you agree to send photos & feedback every 6 months (Y/N) _________