Application Form for Agents

Please fill out the form below to apply as a distributor.
Our representative will contact you shortly after confirming the details of your application.

After filling out the form, please click the "Next" button.
Please enter your information in Japanese or alphabetical characters.

Fields marked with * are required. Please be sure to enter them.

Customer Information

Company/School Name*.
Department name
Name (Kanji) *		Name e.g.) Yamada Name ex) Taro
Name (Katakana) *		ex) Yamada 　 ex)Taro
Phone number*		- - ex)03-1234-5678
Email address		ex)taro@kodensha.co.jp *Please make sure to allow "kodensha.jp" as a domain name if you have restricted receiving mail.
		(Confirmation)
Our office is located at	Zip code*.	- Look up a zip code
	State/Province*	Please select one of the following Hokkaido Aomori Prefecture Iwate Prefecture Miyagi Prefecture Akita Prefecture Yamagata Prefecture Fukushima Prefecture Ibaraki Tochigi Prefecture Gunma Saitama Prefecture Chiba Tokyo Metropolitan Government Kanagawa Prefecture Niigata Toyama Ishikawa Fukui Yamanashi Prefecture Nagano Prefecture Gifu Prefecture Shizuoka Prefecture Aichi Prefecture Mie Prefecture Shiga Prefecture Kyoto Prefecture Osaka Prefecture Hyogo Prefecture Nara Prefecture Wakayama Prefecture Tottori Prefecture Shimane Prefecture Okayama Hiroshima Prefecture Yamaguchi Prefecture Tokushima Kagawa Ehime Prefecture Kochi Prefecture Fukuoka Prefecture Saga Prefecture Nagasaki Prefecture Kumamoto Prefecture Oita Prefecture Miyazaki Prefecture Kagoshima Prefecture Okinawa Prefecture
	City/town/village※	Example)Hayacho, Chiyoda-ku
	Address※	Example)2-13
	Building/apartment name・ Room number	ex)Prime Building 3F

Target Products and Services

Product/Service Category*	Please select one of the following Software Products Automatic Website Translation Automated Translation Platform Other
Correspondence column※

Questionnaire

How did you learn about us?	Google Yahoo! From other search sites Brochure From an agency Referral Other
Keyword(s) in your search

Personal Information

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