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I present it and am campaigned every month

I present heiseigifutosetto to three people a month by lot.
The application, please transmit the following item after input.
 
※It should be successful news with the shipment of the prize.
※One household of election of the prize should be a one-off.
The purchase number of times in our store ※required
Where did you know the product? ※required
The generation ※required
May I see off the guide about the product from our store? ※required
The name ※required
Example) Taro Yamada full size
Furigana ※required
(Hiragana)
Example) yamadatarou full size hiragana letter
Zip code ※required
(Half-width number)
Example) 0123456 half size number
The metropolis and districts ※required
Words and cities municipalities ※required
Address ※required
Building, apartment name
Phone number ※required
(Half-width number)
Example) 0123456789 half size number
E-mail address ※required


Opinion, impression
2020/5/
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2020/6/
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2020/7/
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  • ※The deficit is a holiday
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