To enter simply complete the form below. Limit one entry per laundromat, please.
*Owner First Name:
*Owner Last Name:
*Phone:
*Email:
*Laundromat Name:
*Laundromat Location:
      Address 1:
      Address 2
      City:
      State:
      Zip:
Mailing Address (if different):
      Address 1:
      Address 2
      City:
      State:
      Zip:
  Verification Number
Enter this number in the field below. What's this?
*Verification number:
 

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