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代理銭洗神事申込フォーム
代理銭洗神事を行った後の福銭の送金を行うため、以下の情報の記入をお願いいたします。
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Email
*
Your email
お名前（神事でお名前を言上いたします）
*
Your answer
ふりがな
*
Your answer
メールアドレス
*
Your answer
連絡先電話番号
*
Your answer
銀行名
*
Your answer
支店名（支店番号）
*
Your answer
口座番号
*
Your answer
口座名義
*
Your answer
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