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REARRANGING MEMENTO / CALCULATION

Please refer willingly.
※ is a required item.Please input it.

About applicant

Name  Example) Your Name 
Postcode  Example) 012-3456 
Prefectural and city governments   
Address  Example) 00 XX-cho XX-shi 
Tel  Example) 0123-45-6789 
Fax  Example) 0123-45-6789 
E-mail  Example) user@doamin.tld 
E-mail(check)  

An address of a place doing putting in order

Postcode  Example) 012-3456 
Prefectural and city governments   
Address  Example) 00 XX-cho XX-shi 

About a place doing putting in order

Kind of the building   
Area of the room   
Having elevator or not   
Situation of a road   

About the service that is not included in a basis rate

Service desired (A plural number is possible) If there is the following service that are not included in
a basis rate desired, please put a check. (A plural number is possible)
Memento safekeeping
Buying up of the recycling
The recycling of the home electronics
General garbage disposal processing
The dismantling of the building

About request contents

Preferred date of the putting in orderr  Example) 20090101 
Communication method   
Budget thousand yen Example) 20 
Question / demand  
 

※Please confirm input contents again even if You push the Confirm button when there is not a reply.