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Basic information	Page 1 / 6
Please fill out the below items and click on the "Next" button at the bottom of this page. If an error message appears, please retry.

Name / Sex / Birthday
Name	First Name: Last Name:
Sex	Male Female
Date of birth	/ / (Please type Year/Month/Day [ex. 1969/03/08])
Contact Address / Phone Number
Zip code	(In ***-**** format. [ex. 106-0032])
Prefecture	click and select Hokkaido Aomori Iwate Miyagi Akita Yamagata Fukushima Ibaraki Tochigi Gunma Saitama Chiba Tokyo Kanagawa Niigata Toyama Ishikawa Fukui Yamanashi Nagano Gifu Shizuoka Aichi Mie Shiga Kyoto Osaka Hyogo Nara Wakayama Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Ehime Kochi Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki Kagoshima Okinawa
City	(ex. Chiyoda-ku)
Address1	(ex. 1-6-1, Higashi shimbashi )
Address2	(ex. Hibiya Dai Bldg.)
Address3
Phone Number	(ex. 03-1234-5678)
Fax Number	(ex. 03-1234-5678)
Day Contact Phone Number	(ex. 03-1234-5678)
Credit Card Information
* Please use a credit card registered in your name
Credit Card Company	click and select VISA MASTER DINERS JCB AMERICAN EXPRESS NICOS
Card Number	(ex. 3540012345678901)
Expiration Date	Month 01 02 03 04 05 06 07 08 09 10 11 12 / Year 17 18 19 20 21 22 23 24 25 26 (in Month/Year format)
Mail Address you want to use
1) You can use small letters, numerals, hyphen( - ), and under bar(_) 2) Please type a small alphabet letter as a first letter. 3) Please type 2 to 14 characters 4) The letters "***" are given by us. 5) In case all of your requested mail addresses were already in use, we will inform you to use another address.
1st request	@***.***.ne.jp
2nd request	@***.***.ne.jp
3rd request	@***.***.ne.jp