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* 1. Name: (required for refunds)

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* 2. Date of Visit

Date
Time

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* 3. Please check the reason(s) for your feedback:

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* 4. Details of the issue, feedback or suggestion: (Provide any details that may assist in identifying and resolving the issue. Include machine number. If returning a laundry card, include the balance.)

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* 5. Best way to reach you, provide:
- Phone Number
- Email Address

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* 6. Preferred Refund Method (name required above):
- Cash: Mailing Address
- Venmo: Username

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* 7. Do you have any additional comments or suggestions?

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