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 pay today?	Cash WASHHOUSE App * Required
Which machines did you use today?	Washer Dryer Sneaker Washer Sneaker Dryer * Required
What did you wash (dry) today?	Clothes Shoes Beddings Carpets Curtain Kotatsu duvet Others * 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
What brought you to WASHHOUSE?	* Required
How many members in your family?	Myself only, 2 3 4 More than 5 * Required
Does anyone in your family have a pollen allergy, asthma or atopic dermatitis?	No Pollen allergy Asthma Atopic dermatitis Others * Required
When do you use the coin laundry?	For rainy or cloudy days for sterilizing for washing big items for regular washing for PM2.5 countermeasure Others * Required
Have you watched WASHHOUSE TV advertisement?	YES NO * Required
If you have any other comments, please let us know.

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