Order Form
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Thank you for using our service.
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Be sure to fill out the boxes marked
Your Information
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Last Name
Last name(ex:Shunsuke)
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First Name
First name(ex:Nakamura)
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E-mail Address
(ex:shunsuke@nakamura.com)
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Postal code
(ex:100-0000)
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Address
(ex:5-1-21 Sakae, Naka-ku, Nagoya-shi)
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Tel No.
(ex:03-0000-0000)
Delidery service option
Takkyuubin
Request of shipping date
2012
2013
年
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日
Possibility delivery date:本日より2日以降365日以内でご選択ください。
Request of shipping time
AM
12:00-14:00
16:00-18:00
18:00-20:00
20:00-21:00
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Payment term
Correct on delivery
Bank transfer
Credit Card
Messege
Order form
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Order
Box No.
Amount
[1]
-
[2]
-
[3]
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[4]
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[5]
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The amount is a half size number.
Please fill it out so that the same step makes a pair.
Destination information
When the destination is different from visitor information, please make entry of all the following.
Destination Last name
Last Name(ex:Shunsuke)
destination First name
First Name(ex:Nakamura)
Destination Postal code
(ex:100-0000)
Destination address
(ex:5-1-21 Sakae, Naka-ku, Nagoya-shi)
Destination Tel No.
(ex:03-0000-0000)
CGI's