■ Publicly offered vehicle ■
MAZDA2 Diesel 1.5L 2WD MT car (DJ5FS -600001 ~)

■ Name ■

　Furigana [full-width] ■

■ Email address ■

　E-mail address (for confirmation) ■

■ Address ■
・ Zip code [half-width number]

·Prefectures
---Select the prefecture---HokkaidoAomoriIwateMiyagiAkitaYamagata PrefectureFukushimaIbarakiTochigiGunmaSaitamaChibaTokyoKanagawa PrefectureNiigataToyamaIshikawaFukuiYamanashi PrefectureNaganoGifuShizuoka PrefectureAichiMieShigaKyotoOsakaHyogoNaraWakayamaTottoriShimane OkayamaHiroshimaYamaguchi TokushimaKagawaEhimeKochiFukuokaSagaNagasakiKumamotoOitaMiyazakiKagoshimaOkinawaetc.
・ Municipality [Full-width]

・ Address / building name [full-width]

・ Telephone number [half-width number]

・ Contact column [Full-width]