Lottery application form for new opening shop

* Winners will be notified by delivery of the prize by post.
* Applications will be void for the shops and period not subjected for lottery.
* We shall use your personal information only for the lottery and not for any other purposes.
* We accept one application form per family.

Please fill in the shop name you wish to apply for the promotion
Fisrt Name	* Required
Family / Surname	* Required
Gender	Male Female * Required
Age	* Required
Postal Code	* Required If you enter the postal code, the prefecture and municipality will be displayed automatically.
Prefectures	* Required
Shi, Ku, Gun	* Required
Cho, Ban	* Required
Name of building
Telephone Number	* Required
Mail address	* Required
Confirm mail address	* Required
The day of use
The time of use	:
Please choose the prize you wish	Nintendo Switch 1kg Miyazaki Beef * Required
Occupation	Homemaking Company employee Civil servant Self-employed Unemployed Others * Required
How did you find out about this shop's opening and campaign information?	Saw the advertisement in a newspaper insert Saw the advertisement in a mailbox I heard from acquaintance By Looking at the sign about the opening On the internet Watch the TV Adverting Other * Required
Which transportation did you use from your home to WASHHOUSE?	Car Motorbike Bicycle On foot Others * Required
How long did it take from your home WASHHOUSE?	Within 5 mins 10 mins 30 mins 60 mins More than 61 mins * Required
How did you pay today?	Cash WASHHOUSE App * Required
*If you chose cash, please tell us why you did not use the WASHHOUSE app.
Which machines did you use today?	Washer Dryer Washer-Dryer Combo Sneaker Washer Sneaker Dryer * Required
What did you wash (dry) today?	Clothes Shoes Beddings Carpets Curtain Kotatsu duvet Others * Required
How many members in your family?	Myself only, 2 3 4 More than 5 * Required
When do you use the coin laundry?	For rainy or cloudy days For regular washing For sterilizing For allergies For washing big items Do the laundry in one time When reorganizing closet For washing and drying shoes When traveling or on a business trip Other *Required
How often do you use the coin laundry?	almost every day a few times in a week weekly biweekly monthly a few times in a month * Required
If you have any other comments, please let us know.

: Highly trained operators are available 24 hours a day, 365 day a year.