Service Request Form

If you are here to report a fire, gas leak or any other life-threatening emergency, do not complete this form. Dial 911 immediately. Otherwise, please complete this form including the machine identification number, address and zip code where the machine is located and a brief description of the problem you are experiencing.
Fields with a star (*) are required.
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Contact Information:

First Name*
Last Name*
Phone Number: 
  If you would like a confirmation of this request, please enter your contact information below
Notify By:    
Email Address:    

Service Location:

Property Name*
  Examples: White Dove Apartments or 1234 Main Street
Property Address 
(#*, Name*, Type): 
  Example: 1234MainStreet
State* Zip Code*
Laundry Room Address:  Floor: 
  Examples: 1234 Main St or Building B
(If reporting more than one laundry room address, please enter the additional addresses in the Comments)

Machine Identification:

  Machine Type* Problem Code* Machine ID Position / Notes
Position Example: 3rd washer on the right when you walk in
Machine ID Example: 


Please provide a brief description about the additional locations of the machines that need service and their problems

Coinmach Corporation | Service (877) 264-6622