All fields are required to be filled.


    Your name

    Your e-mail address

    Your tel number

    ※Numbers with "-".
    ※Please provide us a number that we can reach you, if you don't have any - the broken phone number is sufficient

    The Store you like to Visit

    Carrier

    docomoauSoftBankY!MobileRakuten mobileothers

    Model

    *Model that does not appear on the list can not be repaired.

    Code

    Color of the frame

    *Select one which is close to yours.

    Color of the back panel

    *Select one which is close to yours.

    Malfunction

    *If you fall under "others", please write in detail below.

    Status of breakage and malfunction, such reasoning

    How have you found our Shop?
    Serched on the search engineSNS such as Twitter, Instagram, etc.RepeatIntroduction from acquaintancesStore sign boardBanners on the other website

    On which device have you visited our site?
    PCAndroid smartphoneiPhone/iPadothers


    Confirm the inquiry contents above, confirm the policy concerning handling of personal information, agree, inquire.(Check it and you can send it)