申込者名 / Full Name

メールアドレス / E-mail Address

カード番号 / Credit card No.

Example:9999999999999999　Half-width Digit

有効期限 / Expiration Date
( Month / Year )

Month／ Year　
Example: 08/21 Please enter it the same way as it is written on the credit card.

セキュリティコード / Security Code

(3/4 digit number)
※AMEX credit card: on the front of the card, above the card number
For other cards: On the back of the card, a 3 digit number on the signature line