JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request form for Self-isolation facility information service
Our concierge will offer potential rooms when details are confirmed!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
e-mail address
*
Your answer
Estimated move-in date
*
MM
/
DD
/
YYYY
Estimated move-out date
*
MM
/
DD
/
YYYY
Area (Tokyo, Osaka, Naha, Sapporo etc)
Your answer
Approximate price for rent per night
Your answer
No. of residents
*
1
2
3
4
5
more than 6 people
Telephone phone number
Your answer
Required floor plan
*
1Room+1kitchen
1Room+1living room+1kitchen
2Rooms+1living room+1kitchen
3Rooms+1living room+1kitchen
4Rooms+1living room+1kitchen
others
Your Country
Your answer
Which Airport you will arrive at
*
Narita Airport
Haneda Airport
Kansai Airport
Others
Do you need to look for another room to stay in after the quarantine
*
If necessary, we will introduce you another room that meets your requirement.
Yes
No
Others
How did you find our service
Yahoo, Google, other websites
PR times
Introduced by your company
TV
SNS
Introduced by friends
Introduced by Embassy, consulate, etc
Others
Clear selection
Please give us the name of person who introduced our service if applicable
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of matsuri technologies株式会社.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report