To:manager@kyotomall.com
Subject:kyotomall-member
From:[e-mail]


(name):[name]
(〒):[〒]
(STATE):[STATE]
(CITY):[CITY]
(TOWN):[TOWN]
(NUMBER):[NUMBER]
(bill):[bill]
(tel):[tel]
(fax):[fax]
(e-mail):[e-mail]
(性別):[seibetsu]
(その他):[sonota]