Your input page

  • 01 Your input page
  • 02 Forward URL
  • 03 Quote request page
  • 04 Contact by JAPAN LIFE ASSIST
  • 01 Your input page
  • 02 Forward URL
  • 03 Quote request page
  • 04 Contact by JAPAN LIFE ASSIST

Please fill out information of
your acquaintance's address and
interesting products after
input your information.

    Information yourself

    NameMandatory
    Mobile NumberMandatory
    E-mail AddressMandatory
    Zip CodeMandatory

    Address

    Acquaintance Information

    AddressMandatory
    Required productsMultiple selection is available,
    select minimum 1 item
    Photovoltaics
    All Denka(All electric energy, no gas energy)
    IH cooktop
    Carport
    Terrace / Sunroom
    Artificial grass
    Wood deck
    Floor concrete
    Gate / Fence
    Other exterior
    Confirmed above items
    and forward to next.

    You will receive an e-mail message with URL soon.
    Please forward URL to your acquaintance.