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Inquiry Form

After filling out the following item, please push "input contents' confirmation" button (please do not use half size katakana).
Required part is input required item.

Personal information of customer is encrypted by SSL and is protected. We do business consignment and we use for consultation and repair, the confirmation and, about information of customer who had you register, may leave the record for KYUHEN Co., Inc. and our group companies, subcontractor. In addition, we will not provide to third party unless we manage personal information appropriately, and there are case and sufficient reason to entrust with repair duties.

Type of inquiry Essential

※Plurally select; is possible

Name Essential
Furigana Essential
Company name Essential
E-Mail address Essential
Phone number
FAX number
Address
Inquiry contents Essential
Privacy policy Essential

Please choose following "we agree" after agreement for privacy policy.