Home massage application form
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Full name ( First name /  Family name )   *
Telephone number *
Address (1st time only)
Apart name and room number (1st time only)
Do you have our VIP card?   VIPカードをお持ちですか? *
Preferred date (ご希望日) *
MM
/
DD
/
YYYY
Preferred time(ご希望開始時間) *
Time
:
The number of customers *
Preferred therapy ( 1st customer) *
Preferred therapy ( 2nd customer) *
Staff reservation ( +60B extra)   スタッフのご指名(+60Bがかかります)
Remark ( ex. desire strong massage etc.)   特記事項(強い施術希望等)
Submit
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