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["取引条件確認書"]
["株式会社メディア・リースに対する取引条件は、下記の通りです。"]
["記入日（西暦）",null,null,null,null,null,"年",null,null,"月",null,null,"日"]
["フリガナ"]
["会社名"]
["フリガナ"]
["役職・代表者氏名"]
["本社所在地",null,null,"〒"]
[]
["電話番号／FAX番号",null,null,null,null,null,null,null,"／"]
["登記住所と異なる場合",null,null,"〒"]
[]
["電話番号／FAX番号",null,null,null,null,null,null,null,"／"]
["企業情報",null,"設立",null,null,"年",null,"月",null,"資本金　　　　　　　　　",null,null,null,null,"百万円"]
[null,null,"年商",null,null,null,null,"百万円",null,"従業員数",null,null,null,null,"名"]
[null,null,"決算月日",null,null,"月",null,"日","主な取引先"]
[null,null,"事業内容"]
["請求書送付先　住所",null,null,"〒"]
[]
["電話番号／FAX番号",null,null,null,null,null,null,null,"／"]
["フリガナ"]
["経理担当者氏名"]
[]
["取引条件",null,null,"月末締翌月末銀行振込"]
[]
["●申請日と太枠内にもれなくご記入いただき、メールにてご返信ください。"]
["●請求書の送付先が、タイトル・番組ごとに異なる場合は、別に定める用紙にご記入いただきます。"]
["●登記簿謄本（発行日より3か月以内のもの）の原本または写しを必ず添付してください。"]
[null,null,null,null,null,null,null,"承認",null,"審査部",null,"営業部",null,"担当"]
["株式会社メディア・リース"]
["〒107-0052　東京都港区赤坂5-4-17 SCビル赤坂7F"]
["TEL:03-3589-7611 / FAX:03-3589-7600"]