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[null,"介護おむつネット　ＦＡＸ注文書"]
[]
[]
[null,"お申込み専用 ＦＡＸ　０１２０－３９－５３６４ （通信料無料）"]
[null,"↓下記の太枠線の内側のみ、ご記入ください。"]
[]
[null,"お名前\n（ご注文者様）",{"$nulls":4},"お名前\n（お届け先）\n※異なる場合記入"]
[null,null,null,"TEL　　 　 　　－　　    　　－",{"$nulls":5},"TEL　　　　　　－　  　 　　－"]
[null,"ＦＡＸ番号",null,"FAX　　　  　　－　　    　　－",null,null,"メモ欄\n領収名義・配送名義等ご要望"]
[null,"お届け先",null,"〒　　　　　　　－"]
[null,"ご注文日",null,"月　　　　日　　",null,"希望お届け日",null,"月　　　　日　　",null,null,"　●注文受付　平日（　月～金　）\n　●配送休日　土・日・祝祭日"]
[]
[null,"◆ご発注内容",null,"↓下記の太枠線の内側のみ、ご記入ください。"]
[]
[null,"商品名",null,null,null,"単品・箱","個数",null,"備考（種類等）",null,"価格 （税別・弊社記入）"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[{"$nulls":5},"単品・箱",null,"点"]
[null,"※在庫の状況により、メーカーからの直送となる場合がございます。その場合、発送まで4営業日かかります。あらかじめご了承ください。",{"$nulls":6},"合計金額 （税別）"]
[{"$nulls":8},"消費税額"]
[{"$nulls":4},"　代引手数料　（ＦＡＸでのご購入は代引限定です）\n　　ご購入金額合計7000円未満は330円、7000円以上は無料"]
[{"$nulls":4},"　送　料　　（地域別送料となります。下記参照ください）"]
[{"$nulls":4},"合計金額 （税込・弊社記入）"]

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