Wholesale sales application

For those who wish to wholesale sale of "Cure products", please fill out the necessary information from the inquiry form and apply.
※ Wholesale sales will be only real store sales in Japan.

会社名（店舗名）Company Name

ホームページURLURL

ご担当者Your Name

メールアドレスMail Address

メールアドレス
(確認用)Mail Address Confirm

お電話番号Phone Number

ご住所Address

FAX番号Fax Number

販売形態Marketing Method

• Wholesale (wholesale)
• Retail (store)
• EC site
• Other

取扱希望商品Product

• NaturalAqua Gel
• CureBathtime

備考・コメントMail Contents