Program Proposal Form

If you are interested in these technologies, please fill out and submit this form. It will be sent to [email protected] Today's Date: Aug 12, 2008 Organization Name Physical Address Address: City: State/Province: Zip: Country: (if not US) Mailing Address (if different than Physical Address) Address: City: State/Province: Zip: Country: (if not US) Primary Contact Name Primary Contact Phone Primary Contact Email Website (if any) Are you requesting: Equipment   Training Model # 20002796U1 Universal Nut Sheller 20002796P1 Pedal Assembly 20002796P2 Universal Nut Sheller with Pedal Assembly 20002796P3 Universal Nut Sheller with Motor Assembly 20002796U2 Mini-Universal Nut Sheller Quantity Needed for processing Coffee   Shea   Jatropha   Peanuts   Neem What is the intended goal of the organization with regards to using The Full Belly Project's Technology? (Up to 2000 words)