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["ジオグリーンテック株式会社　御中"]
[]
["ＳＨ型データロガー修理・点検整備申込書"]
[]
["発送前にご記入頂き、E-mailにてお送りください。"]
[null,null,"　E-ｍａｉｌ：　shinfo@geogreen.co.jp"]
[]
["◇申込日：","yyyy年","mm月","dd日"]
["◇対象データロガー　の発送日：",null,null,"mm月","dd日"]
["◇対象データロガー　製造番号：   №",null,null,"nnn"]
["◇対象データロガー　打撃回数：",null,null,"nnn,nnn"," ※打撃回数は、切り替えスイッチを\"ＴＥＳＴ\"に入れ\n \" Ｆ \"ボタンを押すと「count」として表示されます。"]
["　　　※耐用打撃回数（150,000回）を超えている場合は修理ができない場合がございます。"]
["◇修理又は点検整備の□をダブルクリックして”レ”で選択して下さい。"]
["□","修　理","□","点検整備"]
["◇機器の状態をご記入ください。"]
[]
[]
[]
[]
["◇申込者"]
["会社名","株式会社〇〇〇○○",null,null,"担当者","○○　○○"]
["住所","〒123-4567"]
[null,"  ○○○○県○○市○○"]
["電話番号","012-345-56789",null,null,"E-ｍａｉｌ"," aaaaaaa@bbbb.ccc.dd"]
["◇整備後のお届け先　※申込者と異なる場合のみご記入ください。"]
["会社名",null,null,null,"担当者"]
["住所","〒"]
[]
["電話番号",null,null,null,"E-ｍａｉｌ"]
["※ご請求金額は機器到着後、状態を確認して申込者様に連絡させていただきます。"]
[]
["◇請求書送付先を□をダブルクリックして”レ”で指定して下さい。"]
["□","申込者","□","お届け先"]
["連絡事項："]