※　Company Name

※ Affiliated Department or Division

※ Name

※ Email Address

※ Phone Number

※ Postal Code

Prefecture (for addresses in Japan)
--Select from the List--HokkaidoAomoriIwateMiyagiAkitaYamagataFukushimaIbarakiTochigiGunmaSaitamaChibaTokyoKanagawaNiigataToyamaIshikawaFukuiYamanashiNaganoGifuShizuokaAichiMieShigaKyotoOsakaHyogoNaraWakayamaTottoriShimaneOkayamaHiroshimaYamaguchiTokushimaKagawaEhimeKochiFukuokaSagaNagasakiKumamotoOitaMiyazakiKagoshimaOkinawa

※ Address

※ Message

Regarding Applications:

• Once your inquiry has been successfully submitted, a “Confirmation of Receipt” mail will be sent to the email address you provide.
• As a general principle, inquiries will be replied to during Company business hours, in the order in which they are received.
• Please note that in order to be selected as a licensee, candidates must successfully complete a screening by the Company, before subsequently concluding a contract separately stipulated by the Company.
• Please note that the Company may be unable to reply regarding details of screening results.
• The disclosure to a third party, publication, or secondary use of replies issued by the Company, in whole or in part, is prohibited.
• By submitting your inquiry, you are deemed to have consented to the above conditions and the “Regarding the Handling of Personal Information” section below.

Regarding the Handling of Personal Information

• Personal information obtained through the above form will be used for the purpose of responding to your inquiry.
• With regard to the handling of personal information by the Company, please refer to our Privacy Policy (in Japanese).