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※ Regarding Handling of Personal Information
Personal information acquired on this site is for the purpose of contacting you, and will not be used for any other purposes
 
Required fields will be marked with " ※"
Title※
Name
E-mail※
E-mail（Re-enter for confirmation）※
Phone Number
Address
Gender※
Purchase date and time (printed on the receipt)※

※ If you have no receipt, please tell us the date and time of purchase.
Purchase store name and 「店No」 Store No. (printed at the bottom right of the receipt)※

※ If you have no receipt, please tell us the name of the store or the location.
「レシートNo」Receipt No. (printed at the bottom left of the receipt)※

※ If you have no receipt, please enter "No" .
If you have any photo of the receipt, please upload here

※ Please take the picture of the whole receipt.
Content of inquiry※
Reply Yes/No※
Personal information acquired on this site will be used only for the purposes of responding to your inquiry, and will not be used for any other purposes * If you agree to the above and disclose or present personal information, please click "Yes" in the checkbox.※

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