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.

 

Fields with a star (*) are required.
For Refunds, Click Here
 
Contact Information:

First Name*: 

Last Name*: 

Phone Number: 
  If you like a confirmation of this request, please enter your contact information below
Notify By:    
Email Address:    
Service Location:

School Name*: 

 

Example: Purdue University (No Abbreviations)

City*: 

State*: 

Zip Code: 

Residence Hall or Address*: 

Floor: 
 

Examples: Jester Residence Hall or 1234 Main Street

(If reporting more than one laundry room address, please enter the additional addresses in the Comments)
Machine Identification:
 

Machine Type*

Problem Code*

Machine ID

Notes

1*: 

2: 

3: 

4: 

5: 

6: 
 

Machine ID Example: 
Comments: Please provide a brief description about the additional locations of the machines that need service and their problems