Glanet collection 撤去希望|Removal request
以下に必要事項を記入の上、送信ください。|Please fill in the necessary items below and submit.
Email address *
撤去対象の商品は何ですか?|What is the item to be removed? *
撤去第一希望日をご指定ください。|Please specify the first desired date of removal. *
MM
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DD
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YYYY
撤去第二希望日をご指定ください。|Please specify the second desired date of withdrawal. *
MM
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DD
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YYYY
撤去第三希望日をご指定ください。|Please specify the third desired date of withdrawal. *
MM
/
DD
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YYYY
氏名|Name *
Your answer
住所|Street address *
Your answer
電話番号|Phone number *
Your answer
撤去に至った理由をお聞かせください|Please tell us the reason for the removal. *
Your answer
Submit
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