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
/
DD
/
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
/
DD
/
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
/
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
Never submit passwords through Google Forms.
This form was created inside of カイト株式会社. Report Abuse - Terms of Service - Additional Terms