咲乱USER
 PLEASE INPUT SETTLEMENT INFORMATION *IS REQUIRED
NAME *
PLEASE INPUT YOUR FULL NAME.
CAPITAL *
PLEASE SELECT PREFECTURE.
COUNTRY *
PLEASE SELECT THE NAME OF A COUNTRY.
ADDRESS *
PLEASE INPUT THE ADDRESS.
PLEASE INPUT THE NAME OF BUILDING OR APARTMENT.
TEL *
PLEASE OMIT HYPHEN "-". (NUMERIC)
EMAIL ADDRESS
(ALPHANUMERIC)
NOTE
    
CARD IS AVAILABLE IF ANY OF THESE MARKS ARE ATTACHED.
AMOUNT*  yen
CARDHOLDER'S NAME*
CARDHOLDER'S NAME ON THE CARD.(ALPHANUMERIC)
CARD NO*
PLEASE INPUT 14-16 DIGIT NUMBER WITHOUT HYPHEN "-" AND SPACE
EXPIRATION DATE*  / 
PLEASE INPUT MONTH AND YEAR (MM/YYYY)
CARD CVV2 *
WHAT IS CVV2 NUMBER?
This credit card payment system is provided by Maxconnect.
PLEASE INPUT PERSONAL INFORMATION AFTER CONFIRM PRIVACY POLICY OF OUR COMPANY.

FOR ANY INQUIRY
CREDIT CARD SUPPORT CENTER
　Tel: 03-6826-5621 (WEEKDAYS: 10:00-20:00)
INQUIRY E-MAIL ADDRESS
　payment@maxconnect.co.jp











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