*Name of store

Name of person in charge

*Telephone number (store)

*Email address

*Prefecture
Hokkaido (northernmost of the four main islands of Japan)Aomori prefecture (Tohoku area)Iwate prefecture (Tohoku area)Miyagi prefecture (Tohoku area)Akita prefecture (Tohoku area)Yamagata prefecture (Tohoku area)Fukushima prefecture (Tohoku area)Ibaraki prefecture (Kantou area)Tochigi prefecture (Kantou area)Gunma prefecture (Kantou area)Saitama prefecture (Kantou area)Chiba prefecture (Kantou area)Tokyo Metropolitan areaKanagawa prefecture (Kantou area)Niigata prefecture (Hokuriku area)Toyama prefecture (Hokuriku area)Ishikawa prefecture (Hokuriku area)Fukui prefecture (Hokuriku area)Yamanashi prefecture (Chuubu area)Nagano prefecture (Chuubu area)Gifu prefecture (Chuubu area)Shizuoka prefecture (Chuubu area)Aichi prefecture (Chuubu area)Mie prefecture (Kinki area)Shiga prefecture (Kinki area)Kyoto (metropolitan area)Osaka (metropolitan area)Hyogo prefecture (Kinki area) (Hyougo)Nara prefecture (Kinki area)Wakayama prefecture (Kinki area)Tottori prefecture (Chuugoku area)Shimane prefecture (Chuugoku area)Okayama prefecture (Chuugoku area)Hiroshima prefecture (Chuugoku area)Yamaguchi prefecture (Chuugoku area)Tokushima prefecture (Shikoku)Kagawa prefecture (Shikoku)Ehime prefecture (Shikoku)Kouchi (Kochi) prefecture (Shikoku)Fukuoka prefecture (Kyushu)Saga prefecture (Kyushu)Nagasaki prefecture (Kyushu)Kumamoto prefecture (Kyushu)Oita prefecture (Kyushu)Miyazaki prefecture (Kyushu)Kagoshima prefecture (Kyushu)Okinawa prefecture (including Okinawa island)Taiwan/TAIWANOther

Store Address

*Use TOKIKATA type
BIGAMISUGAMIboth

TOKIKATA Serial No.
*If you have a TOKIKATA, please check the back side or the warranty card at the time of purchase.
Example: 0000 4 digits

Instagram (if you wish)
*Example of entry @tokikata

HP (if you wish)
*Example entry: https://tokikata.jp/

Δ