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.

必須会社名（店舗名）Company Name

必須ホームページURLURL

必須ご担当者Your Name

必須メールアドレスMail Address

任意メールアドレス
(確認用)Mail Address Confirm

必須お電話番号Phone Number

必須ご住所Address

任意FAX番号Fax Number

必須販売形態Marketing Method

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

必須取扱希望商品Product

• NaturalAqua Gel
• CureBathtime

必須備考・コメントMail Contents