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 * 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 * Required
Occupation * Required
How did you pay today? * Required
Which machines did you use today? * Required
What did you wash (dry) today?
* Required
Which transportation did you use from your home to WASHHOUSE? * Required
How long did it take from your home WASHHOUSE? * Required
What brought you to WASHHOUSE? * Required
How many members in your family? * Required
Does anyone in your family have a pollen allergy, asthma or atopic dermatitis? * Required
When do you use the coin laundry? * Required
Have you watched WASHHOUSE TV advertisement? * Required
If you have any other comments, please let us know.
Call Center: Free24/7 0120-545-696
Highly trained operators are available 24 hours a day, 365 day a year.