PRELIMINARY SITE SURVEY – LAUNDRY BOSS - MU INFORMATION REQUIRED FOR INSTALLATION PROPOSAL / SERVICE ORDER Section 1 - General informationPlease complete the following for EACH location to be installed. If you have more than one laundromat / location, the form will automatically provide input fields for each physical location independently.Legal company name*Contact name* First Last Email Address* Enter Email Confirm Email Phone*How many physical locations will be installed?*Each laundromat is considered a physical location. Please select the number of locations so we may provide you with accurate pricing information.One (1)Two (2)Three (3)Four (4)Five (5)More than five (5+)ATTENTION! You have selected that you have more than five (5) locations. Please complete and submit this form for the first five locations AND then please begin again for any additional locations until you have completed the information for all locations. Thank you.Laundromat / Location 01 detailsPhysical address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the dimensions of the laundromat: (ie. 100’ X 60’)*Number of washers at location*Please enter a value between 1 and 1000.Make and models of washers*Please provide details for each type of machine you have at this location.Number of dryers at location*Please enter a value between 1 and 1000.Make and models of dryers*Please provide details for each type of machine you have at this location.Do your machines currently accept credit cards?*YesNoNumber of kiosks to be installed*Enter 0 if you will not be having any kiosks installed.Please enter a value between 0 and 10.What type of kiosk(s) will be installed (if applicable)* Credit, Bill and Coin VAK (CRBCFL-VAK) Credit Card-Only VAK (CR-VAK) Credit and Bill VAK (CRB-VAK) Credit, Bill and Coin VAK (CRBCRL-VAK) I am not sure of the type Is power currently available within 5 feet of each desired kiosk location?*YesNoPlease let us know of any constraints for installation such as hours, days, etc.Please provide as-built drawings of the locations of all equipment including washers, dryers, office spaces and other details including the desired placement of all kiosks.(If as-built drawings are not available please provide a sketch of this info including the desired placement of all kiosks.) Drop files here or Accepted file types: jpg, gif, png, pdf. Laundromat / Location 02 detailsPlease add details for only your second location in this section.Location 02 - Physical address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the dimensions of the laundromat: (ie. 100’ X 60’)*Number of washers at location*Please enter a value between 1 and 1000.Make and models of washers*Please provide details for each type of machine you have at this location.Number of dryers at location*Please enter a value between 1 and 1000.Make and models of dryers*Please provide details for each type of machine you have at this location.Do your machines at this location currently accept credit cards?*YesNoNumber of kiosks to be installed at this location*Enter 0 if you will not be having any kiosks installed.Please enter a value between 0 and 10.What type of kiosk(s) will be installed* Credit, Bill and Coin VAK (CRBCFL-VAK) Credit Card-Only VAK (CR-VAK) Credit and Bill VAK (CRB-VAK) Credit, Bill and Coin VAK (CRBCRL-VAK) I am not sure of the type Is power currently available within 5 feet of each desired kiosk location?*YesNoPlease let us know of any constraints for installation at this location such as hours, days, etc.Please provide as-built drawings of the locations of all equipment including washers, dryers, office spaces and other details including the desired placement of all kiosks.(If as-built drawings are not available please provide a sketch of this info including the desired placement of all kiosks.) Drop files here or Accepted file types: jpg, gif, png, pdf. Laundromat / Location 03 detailsPlease add details for only your third location in this section.Location 03 - Physical address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the dimensions of the laundromat: (ie. 100’ X 60’)*Number of washers at location*Please enter a value between 1 and 1000.Make and models of washers*Please provide details for each type of machine you have at this location.Number of dryers at location*Please enter a value between 1 and 1000.Make and models of dryers*Please provide details for each type of machine you have at this location.Do your machines at this location currently accept credit cards?*YesNoNumber of kiosks to be installed at this location*Please enter a value between 0 and 10.What type of kiosk(s) will be installed (if applicable)* Credit, Bill and Coin VAK (CRBCFL-VAK) Credit Card-Only VAK (CR-VAK) Credit and Bill VAK (CRB-VAK) Credit, Bill and Coin VAK (CRBCRL-VAK) I am not sure of the type Is power currently available within 5 feet of each desired kiosk location?*YesNoPlease let us know of any constraints for installation at this location such as hours, days, etc.Please provide as-built drawings of the locations of all equipment including washers, dryers, office spaces and other details including the desired placement of all kiosks.(If as-built drawings are not available please provide a sketch of this info including the desired placement of all kiosks.) Drop files here or Accepted file types: jpg, gif, png, pdf. Laundromat / Location 04 detailsPlease add details for only your fourth (4th) location in this section.Location 04 - Physical address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the dimensions of the laundromat: (ie. 100’ X 60’)*Number of washers at location*Please enter a value between 1 and 1000.Make and models of washers*Please provide details for each type of machine you have at this location.Number of dryers at location*Please enter a value between 1 and 1000.Make and models of dryers*Please provide details for each type of machine you have at this location.Do your machines at this location currently accept credit cards?*YesNoNumber of kiosks to be installed at this location*Please enter a value between 0 and 10.What type of kiosk(s) will be installed (if applicable)* Credit, Bill and Coin VAK (CRBCFL-VAK) Credit Card-Only VAK (CR-VAK) Credit and Bill VAK (CRB-VAK) Credit, Bill and Coin VAK (CRBCRL-VAK) I am not sure of the type Is power currently available within 5 feet of each desired kiosk location?*YesNoPlease let us know of any constraints for installation at this location such as hours, days, etc.Please provide as-built drawings of the locations of all equipment including washers, dryers, office spaces and other details including the desired placement of all kiosks.(If as-built drawings are not available please provide a sketch of this info including the desired placement of all kiosks.) Drop files here or Accepted file types: jpg, gif, png, pdf. Laundromat / Location 05 detailsPlease add details for only your fifth (5th) location in this section.Location 05 - Physical address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the dimensions of the laundromat: (ie. 100’ X 60’)*Number of washers at location*Please enter a value between 1 and 1000.Make and models of washers*Please provide details for each type of machine you have at this location.Number of dryers at location*Please enter a value between 1 and 1000.Make and models of dryers*Please provide details for each type of machine you have at this location.Do your machines at this location currently accept credit cards?*YesNoNumber of kiosks to be installed at this location*Enter 0 if you will not be having any kiosks installed.Please enter a value between 0 and 10.What type of kiosk(s) will be installed (if applicable)* Credit, Bill and Coin VAK (CRBCFL-VAK) Credit Card-Only VAK (CR-VAK) Credit and Bill VAK (CRB-VAK) Credit, Bill and Coin VAK (CRBCRL-VAK) I am not sure of the type Is power currently available within 5 feet of each desired kiosk location?*YesNoPlease let us know of any constraints for installation at this location such as hours, days, etc.Please provide as-built drawings of the locations of all equipment including washers, dryers, office spaces and other details including the desired placement of all kiosks.(If as-built drawings are not available please provide a sketch of this info including the desired placement of all kiosks.) Drop files here or Accepted file types: jpg, gif, png, pdf. CommentsThis field is for validation purposes and should be left unchanged.
