ニッテルコミュニケーションズ
 
ニッテルコミュニケーションズ

レンタル携帯電話お申し込みフォーム


This is application form of our rental mobile and rental mobile wifi router in Japan.
This page is protected by SSL (Secure Socket Layer) technology, it transmits information safely.

* Please click the "Send"button at the bottom of this page once filling in necessary information.

1. Confirmation of rental period and call plan
Rental Start Date
Rental device delivery date
Year Month Day
* Please order 10 days before use.
Rental Finish Date

Return set drop into the post box
Year Month Day

How many device Unit
Plan
Insurance
* damage (80%compensation) / lost (50%compensation)
Airport Pick Up
* Please refer Business hours of airport pick up counter. here
For Airport Pickup
Date of arrival: Year Month Day
Time of arrival:
Flight Number
Delivery Address
If you don't choose airport pickup, please fill delivery address.
Confirmation
Rental Term

Rental Fee
Yen
Delivery Fee
Yen
Insurance
Yen
Airport Pick up
Yen
Tax
Yen

Total
Yen
* This is not including call charge
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2. Customer's information

Name* First name Surname:
Company
Gender* Male
Femail
Date of birth* Year Month Day
* When people of less than 21 years old will use in this service, a contract person must be adults, such as a guardian or a brother.
* In following order : [Year] [Month] [day]
E-mail address*
E-mail address (to confirm)*
Residential address*
Telephone number to contact*
Passport number*

3. Payment
* People who does not have credit card can not apply this service.
* The credit card information is protected by SSL.。

Paymethod
※credit card only
credit card VISA Master
credit card holder
credit card number - - -
security number (CVV2)


* This is the numbers of 3-4 digits in the back of a credit card, and near the signature column.

expire date Year Month
* In following order : [Year] [Month]
Credit card authorization * Please acknowledge using your credit card for your payment, otherwise this contract can not be made.
agree do not agree

4. Term and condition


※If do not agree you can not order
Agreement for japan rental mobile and mobile wifi router
10/Apr/2013 Updateed

Agreement Agree Do not agree
other inquiry * Please feel free to fill in if you have any request. We are happy to help.




※Please click upper botton automaticaly change page