SENSHIN VEHICLE DONATION PROGRAM



              If you would like to donate
       your car, truck, van, RV, boat, etc
                     to Senshin,
      please let Rev Mas know or contact
          Satoshi at (310) 324-7971 or
         Jean Minami at (323) 938-0048



Name  _________________________________________________________________

Address  _______________________________________________________________

City  ___________________________________  Zip ___________________________

Phone  __________________________    e-mail _______________________________

Type of Vehicle:   Year _________     Make  _____________   Model  ______________

Vehicle LIcense #  _____________________     Odometer Reading _________________

Vehicle Identificaiton # (VIN)  ______________________________________________

Location of Vehicle ______________________________________________________

Is Vehicle driveable ?  Yes   No

Do you have title (pink slip) ?   Yes   No

Name on title  ________________________