Delivery massage form
Email address *
Full name ( First name / Family name ) *
Telephone number *
LINE ID ( LINE contact applicant、ライン連絡希望の方、)
Address (1st time only)
Apart name and room number (1st time only)
Do you have our VIP card? VIPカードをお持ちですか? *
Preferred date (ご希望日) *
MM
/
DD
/
YYYY
Preferred time(ご希望開始時間) *
Time
:
The number of customers *
Preferred therapy ( 1st customer) *
Preferred therapy ( 2nd customer)
Clear selection
Staff reservation ( +80B extra) スタッフのご指名(+80Bがかかります)
Remark ( ex. desire female therapist / strong massage etc.) 特記事項(女性スタッフ希望、強い施術希望等)
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy