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＞ 寄附金の申し込み
地域政党 日本新生への寄附金の申し込みは、下記フォームより申し込みできます。
なお、以下のフォームで、
※
印の項目は入力必須となっています。漏れのないように入力してください。
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ご住所
※
〒
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お名前
※
姓
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フリガナ
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姓
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ご職業
※
お選びください。
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>専門的・技術的職業従事者
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>事務従事者
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>販売従事者
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>運搬・清掃・包装等従事者
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>その他
電話番号
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FAX
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メールアドレス
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メールアドレス確認
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寄附金
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入金（振込み）方法
※
お選びください。
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>郵便局（ゆうちょ銀行）経由
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>銀行など金融機関経由
入金予定時期
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その他（寄附金申込みである旨を記入）
※
<br /> <font size='1'><table class='xdebug-error xe-notice' dir='ltr' border='1' cellspacing='0' cellpadding='1'> <tr><th align='left' bgcolor='#f57900' colspan="5"><span style='background-color: #cc0000; color: #fce94f; font-size: x-large;'>( ! )</span> Notice: Undefined index: message in /home/users/1/nipponshinsei/web/nipponshinsei.jp/donation/index.php on line <i>270</i></th></tr> <tr><th align='left' bgcolor='#e9b96e' colspan='5'>Call Stack</th></tr> <tr><th align='center' bgcolor='#eeeeec'>#</th><th align='left' bgcolor='#eeeeec'>Time</th><th align='left' bgcolor='#eeeeec'>Memory</th><th align='left' bgcolor='#eeeeec'>Function</th><th align='left' bgcolor='#eeeeec'>Location</th></tr> <tr><td bgcolor='#eeeeec' align='center'>1</td><td bgcolor='#eeeeec' align='center'>0.0002</td><td bgcolor='#eeeeec' align='right'>233416</td><td bgcolor='#eeeeec'>{main}( )</td><td title='/home/users/1/nipponshinsei/web/nipponshinsei.jp/donation/index.php' bgcolor='#eeeeec'>.../index.php<b>:</b>0</td></tr> </table></font>
皆さまから入力いただいた個人情報は、 政治資金収支報告書の作成等に利用させていただきます。
それ以外の目的で使用することはございません。
