| 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: |  |