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
必須取扱希望商品Product
必須備考・コメントMail Contents