Three times blanket purchase application form

zamaana Kuroshio Current service three times blanket purchase application

zamaana Kuroshio Current service application acceptance start!

We send delicious thing of Tosashimizu.
Application deadline / Saturday, March 31, 2018
(◆ delivery becomes in winter in autumn in spring in flight December in flight October in flight April.)

  • We see the details
  • Order form for three times collective FAX

Please set set domain refusal by unwanted e-mail measures to receive email of the following domains.
The domain designated reception: shimizu-kankou .com

[to automatic customer whom we input and set]
You may be displayed at the time of input of form saying "automatic input of credit card becomes invalid because this form does not use safe connection", but can use without problem.

Mark is required item. Please input by all means.

The applicant name 
Applicant furigana 
Applicant address  ■Zip code
-
■The metropolis and districts, municipality

■Chome, address (please input ※ building name, room number.)
(example) 1-1-1 ○○ apartment 111

■Company name
Phone number  - -
E-Mail address 
E-mail address (confirmation) 
※For confirmation, please input once again.
Payment method  ※Yamato Transport Co., Ltd. C.O.D. is available only when we send flight to home in spring.
※Payment becomes lump sum payment.
Message If there is message, request, please contact.

The spring convenience destination

About the destination
Name 
Furigana 
Address  ※We cannot send Okinawa, Hokkaido, Akita, Aomori, remote island.
■Zip code
-
■The metropolis and districts, municipality

■Chome, address (please input ※ building name, room number.)
(example) 1-1-1 ○○ apartment 111

■Company name
Phone number  - -
Auspicious decoration for gifts Other one, please input contents as follows.
Option Tosa Giraud egg [1,500 yen] Set
Bakery Pomie roll (Matcha) [1,250 yen] Book
Chotaro shellfish [1,200 yen] Set
Knob Souda Bushi [560 yen] to eat Bag

The autumn convenience destination

About the destination
Name 
Furigana 
Address  ※We cannot send Okinawa, Hokkaido, Akita, Aomori, remote island.
■Zip code
-
■The metropolis and districts, municipality

■Chome, address (please input ※ building name, room number.)
(example) 1-1-1 ○○ apartment 111

■Company name
Phone number  - -
Auspicious decoration for gifts Other one, please input contents as follows.
Option Bakery Pomie roll (cream) [1,000 yen] Book
Seasonal sake lees dried fish set [900 yen] Set
Additive-free handmade miso [780 yen] Unit
Princess bonito [three set] [500 yen] Set

The winter convenience destination

About the destination
Name 
Furigana 
Address  ※We cannot send Okinawa, Hokkaido, Akita, Aomori, remote island.
■Zip code
-
■The metropolis and districts, municipality

■Chome, address (please input ※ building name, room number.)
(example) 1-1-1 ○○ apartment 111

■Company name
Phone number  - -
Auspicious decoration for gifts Other one, please input contents as follows.
Option Ise lobster [3,500 yen] Unit
Chotaro shellfish [1,200 yen] Set
Tosa Buntan(citrus fruit) [1,000 yen] Set
Lemon cake [800 yen] Set