Winter flight application form

Winter convenience application

zamaana Kuroshio Current service application acceptance start!

We send delicious thing of Tosashimizu.
Application deadline / Friday, November 30, 2018
(delivery is December.)

  • We see the details

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 
Message If there is message, request, please contact.

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.
Brand name zamaana Kuroshio Current service [winter convenience] 
・Option
Ise lobster
[3,500 yen] 
Chotaro shellfish [1,200 yen] 
Tosa Buntan(citrus fruit) [1,000 yen] 
Lemon cake [800 yen] 

◆When there is multiple destination, please input at the following.

Destination (2)
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.

■Company name
Phone number  - -
Auspicious decoration for gifts Other one, please input contents as follows.
Brand name  zamaana Kuroshio Current service [winter convenience] 
・Option

Ise lobster [3,500 yen] 
Chotaro shellfish [1,200 yen] 
Tosa Buntan(citrus fruit) [1,000 yen] 
Lemon cake [800 yen] 
Destination (3)
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.

■Company name
Phone number  - -
Auspicious decoration for gifts Other one, please input contents as follows.
Brand name  zamaana Kuroshio Current service [winter convenience] 
・Option

Ise lobster [3,500 yen] 
Chotaro shellfish [1,200 yen] 
Tosa Buntan(citrus fruit) [1,000 yen] 
Lemon cake [800 yen]