Please fill in the shop name you wish to apply for the promotion
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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 |
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Telephone Number |
* Required |
Mail address |
* Required |
Confirm mail address |
* Required |
The day of use |
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The time of use |
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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?
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* Required
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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
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When do you use the coin laundry? |
* Required
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Have you watched WASHHOUSE TV advertisement? |
* Required |
If you have any other comments, please let us know. |
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