Company Name (required)
Name of Person in Charge (required)
Postal Code (required)
Your Business URL
Type of Business/Concept(required)
Image of store interior and exterior.Please attach your images to listed below.（Maximum of 5MB）
Publication・（Magazine, Television, Internet, Other）
Magazine Television Internet Other
If a model will be wearing the clothing, what is the model’s name?
Period of Publication/ (from Y/M/D ~ until Y/M/D)
How long will you need item for media use/ (from Y/M/D ~ until Y/M/D)
Requested Item/ (Product Name, Colour, Size, Quantity)
How did you find out about us?
Type the characters you see in the picture below (required)