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REARRANGING MEMENTO / CALCULATION

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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 　
　

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