| Country: | 
			  | 
			 
			  | 
			
			
			 | Town: | 
			  | 
			 ------- Or specify new: ------- 
			 Town: 
			  | 
			
			
			 | Venue name: | 
			  | 
		 -------- Or specify new: ------ 
		 Venue name:  
		 Address:  
		 Postcode:    
		 Website: http:// 
		 Streetview URL:    
		 Venue Type:  
		  | 
		
	
	 | Machine: | 
	  | 
	 -------- Or specify new: ----- 
 Machine:  
	 IPDB No:     
	  | 
	
	
	
	 | Condition: | 
	 
 
	 | 
	
	
	 | Cost per game: | 
	  | 
	
	
	 Comments: (Please set condition  to 'Pinball Removed'  if appropriate) | 
	  | 
	
	
	 | (Optional) Your Email: | 
	  | 
	
	
	 | (Optional) Your name: | 
	  | 
	
	
	 | Sighting date(yyyy-mm-dd): | 
	  | 
	
	
	| Please enter the letters shown: | 
	  |