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If you are here to report a fire, gas leak or any other life-threatening emergency,
do not complete this form. Dial 911 immediately.
Otherwise, please complete this form including the machine identification number,
address and zip code where the machine is located and a brief description of the
problem you are experiencing.
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Fields with a star (*) are required.
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For Refunds, Click Here
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Contact Information:
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First Name*:
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Last Name*:
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Phone Number:
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If you like a confirmation of this request, please enter your contact information below
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Notify By: |
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Email Address: |
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Service Location: |
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School Name*:
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Example: Purdue University (No Abbreviations)
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City*:
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State*:
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Zip Code:
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Residence Hall or Address*:
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Floor:
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Examples: Jester Residence Hall or 1234 Main Street
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(If reporting more than one laundry room address, please enter the additional addresses
in the Comments)
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Machine Identification: |
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Machine Type*
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Problem Code*
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Machine ID
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Machine 1*:
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Machine 2:
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Machine 3:
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Machine 4:
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Machine 5:
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Machine 6:
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Machine ID Example:
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Comments: |
Please provide a brief description about the additional
locations of the machines that need service and their problems |
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