Full Name (Required)
furigana (optional)
Phone number or e-mail address required
Zip code (required *No hyphen required)
Address (required)
Identification documents (attached) (required) Driver's license (front and back)Health insurance card (front and back)My number cardPassportOthers (Residence card, etc.)
※Select files
Application Amount ( Required)
Gift certificate number 1
Gift certificate face value 1
Gift certificate number 2
Gift certificate face value 2
Gift certificate number 3
Gift certificate face value 3
Gift certificate number 4
Gift certificate face value 4
Gift certificate number 5
Gift certificate face value 5
Gift certificate number 6
Gift certificate face value 6
Gift certificate number 7
Gift certificate face value 7
Gift certificate number 8
Gift certificate face value 8
Gift certificate number 9
Gift certificate face value 9
Gift certificate number 10
Gift certificate face value 10
Add a payment method item (required) Wire TransferCashVirtual Currency ※-Please select one of the following
Bank transfer information (optional)
Bank Name
Branch name
Account type
Account No.
Account Name
Attachment (optional) ※Select files ※Please attach an Excel file with the date/name/gift code.
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