Please answer following questions

Mail Station Ebisu
Purpose Question Estimate Application
Name
Sex Male Female
Address
Occupation
TEL
FAX
E-mail
Date of Birth
Basic Service Mail Box Secretary
Option Service Mail Forwarding Registered Mail & Parcel Holding Fax E-mail Message Transmission
How long will you need the service?
Private Use/ Corporate Use Private Use Corporate Use
Corporate Name
How did you get to know Mail Station Ebisu? Newspaper Magazine Leaflet Internet Other
Question/Remark