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.
Contact Information:

First Name*: 

Last Name*: 

Your Phone Number: 

Your 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 St

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

Machine Type*

Problem Code*

Machine ID

Machine 1*: 
 -

Machine 2: 
 -

Machine 3: 
 -

Machine 4: 
 -

Machine 5: 
 -

Machine 6: 
 -
 

Machine ID Example:
Comments (Service Only):   Please provide a brief description about the additional location of the machines that need service, their IDs, and problems

 

 
 

Do not enter refund information within the comments.