Company Name (required)

Name of Person in Charge (required)

Postal Code (required)


Contact Number(required)

E-mail Address(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)