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お米の事前注文・配達受付フォーム
お米の事前注文・配達受付フォーム
来店前の事前精米・お米の配達を承ります。
お米の事前注文・配達受付フォーム
  • 1
    お米のお受取方法をご選択ください
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  • 2
    Pick a Date
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  • 3
    選択肢以外のkg数をご用命の場合は、お電話にてご注文ください
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  • 4
    複数の品種をご注文の場合は、お電話にてご注文ください
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  • 5
    複数の品種をご注文の場合は、お電話にてご注文ください
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  • 6
    複数の品種をご注文の場合は、お電話にてご注文ください
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  • 7
    配達時のご希望の決済方法をご選択ください
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  • 8
    ご依頼主様のお名前をご入力ください
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  • 9
    ご入力いただいたメールアドレス宛に、ご注文内容をご案内いたします
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  • 10
    配達時にご不在の際や、ご来店の際にご連絡させて頂く場合がございます
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  • 11
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
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    • Colombia
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    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
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    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
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    • Equatorial Guinea
    • Eritrea
    • Estonia
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    • Liechtenstein
    • Lithuania
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    • Macau
    • Macedonia
    • Madagascar
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    • Maldives
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    • Mozambique
    • Myanmar
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    • Netherlands
    • Netherlands Antilles
    • New Caledonia
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    • Nigeria
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    • Norway
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    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
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    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 12
    何かご要望等ございましたら、こちらの欄にご記入ください
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