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[null,"入力チェック（0=未チェック、1＝チェック済）","申込枚数"]
["新規1_その1",0]
["新規1_その2",0]
["新規1_その3",0]
["新規1_その4",0,1]
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[null,"別記様式１（その１）"]
[]
[null,null,null,null,null,null,null,"ＥＴＣコーポレートカード利用申込書"]
[]
[null,"東日本高速道路株式会社"]
[null,null,null,null,null,null,null,null,null,"殿"]
[]
[null,"私は、ＥＴＣコーポレートカード利用約款、ＥＴＣ利用規程、ＥＴＣコーポレートカードの利用に係るプライバシーポリシー及び貴社が定める特約の全てを承諾するとともに、ＥＴＣコーポレートカード利用案内書を了知のうえ、ＥＴＣコーポレートカードの利用を申し込みます。"]
[null,"①申込年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,null,"月",null,null,"日"]
[null,"②おところ",null,null,null,null,null,null,null,null,"(ふりがな)"]
[null,null,null,null,null,null,null,null,null,null,"〒",null,null,null,"-"]
[]
[]
[]
[null,"③お名前",null,null,null,null,null,null,null,null,"(ふりがな)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[null,"④電話番号",null,null,null,null,null,null,null,null,null,null,null,null,"-",null,null,null,null,"-"]
[null,"⑤ＥＴＣコーポレートカード申込枚数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,"⑥高速国道等のご利用見込月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,"カ ー ド\n取扱道路\n管理者の\n道　　路",null,null,"⑦本四高速のご利用見込月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,"⑧首都高速のご利用見込月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,"⑨阪神高速のご利用見込月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,null,null,null,"⑩公社道路のご利用見込月額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,"⑪合計額（＝⑥＋⑦＋⑧＋⑨＋⑩）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(Q20:AF24)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[null,"⑫私は貴社が定める「ＥＴＣコーポレートカード利用約款」につきまして、"]
[]
[]
[null,"(注)",null,"③…法人（事業協同組合を含みます。）でお申込みの場合は、法人名及び代表者名を記入して下さい。"]
[null,null,null,"⑥⑦⑧⑨⑩…各道路の利用実績が把握できる方は、それぞれのご利用最高月額をご記入下さい。"]
[null,null,null,"⑫…いずれかの○に●（チェック）を入れてご回答下さい。なお、承諾なき場合は、利用申込を受け付ける\n　　　ことはできませんので、ご了承下さい。"]
[]
[]
[]
[]
[]
[]
[null,null,"未入力の項目があります｡確認し入力して下さい｡"]

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[null,"別記様式１（その２）　"]
[]
[null,null,null,null,null,null,"ＥＴＣコーポレートカード利用申込書"]
[]
[null,"お　名　前   ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[null,null,null,null,"法人（事業協同組合を含みます。）でお申込みの場合は、法人名及び代表者名を記入して下さい。"]
[null,"⑬請　求　書\n　 送　付　先",null,null,null,null,null,"　　　②の「おところ」と請求書送付先が同じ場合はチェック　※「ご担当者名」「TEL」は入力ください。"]
[null,null,null,null,null,null,null,"(ふりがな)　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(ふりがな)　"]
[null,null,null,null,null,null,null,"〒",null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,"(ご担当者名)"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL",null,null,null,null,"-",null,null,null,"-"]
[null,"⑭ＥＴＣｺｰﾎﾟﾚｰﾄ\n　　ｶｰﾄﾞ管理担当\n　　者 の お 名 前",null,null,null,null,null,"　　⑬と同じ場合はチェック",null,null,null,null,null,null,null,null,null,null,null,null,"⑮支払担当者\n　　の お 名 前",null,null,null,null,null,"　　⑬と同じ場合はチェック"]
[null,null,null,null,null,null,null,"(ふりがな)　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(ふりがな)　"]
[]
[]
[null,null,null,null,null,null,null,"TEL",null,null,null,null,"-",null,null,null,"-",null,null,null,null,null,null,null,null,null,"TEL",null,null,null,null,"-",null,null,null,"-"]
[null,"⑯保証の方法",null,null,null,null,null,null,null,null,null,null,"連帯保証人(銀行等名)　※取扱支店等名もご記入下さい。"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL",null,null,null,null,"-",null,null,null,"-"]
[null,"⑰車載器管理\n　　番号の届出",null,null,null,null,null,"利用約款第３条第３項第２号ただし書きに該当する場合は、別記様式１（その４）に定める\n「車載器管理番号」欄は記入せず、次のいずれかの○に●（チェック）を入れてご回答下さい。"]
[]
[null,null,null,null,null,null,null,"「私は利用約款第４条第２項第１号に定めるとおり、貴社からの利用申込みの受付結果の通知を確認した後、\n直ちに車載器を取得し、届け出た車両にセットアップすることについて、」"]
[]
[null,null,null,null,null,null,null,"【　　　　　　　　　　　　　　　　　　　　・　　　　　　　　　　　　　　　　　　　　　　　】"]
[null,"(注)⑬…②③④と異なる場合のみ記入して下さい。"]
[null,"⑭⑮…⑬と異なる場合のみ記入して下さい。"]
[null,"⑯…いずれかの○に●（チェック）を入れてご回答下さい。なお、保証書による場合は、「連帯保証人」欄を記入して下さい。"]
[]
[null,"※窓口会社使用欄（お客様はご記入しないで下さい。）"]
[null,"台帳番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"交換期限",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,"受　付",null,null,null,null,null,"審　査",null,null,null,null,null,"データ登録",null,null,null,null,null,"カード作成"]
[null,"担当者印"]
[null,"日　付\n（　　　　　　　年）"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,"未入力の項目があります｡確認し入力して下さい｡"]

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[null,"別記様式１（その３）"]
[]
[null,null,null,null,null,"ＥＴＣコーポレートカード利用申込書"]
[null,null,null,null,null,"（ＥＴＣコーポレートカードの利用申込みに係る誓約書）"]
[]
[]
[null,null,"東日本高速道路株式会社"]
[null,null,"北 海 道 支 社 長",null,null,null,null,null,"殿"]
[]
[]
[null,null,"私は、貴社発行のＥＴＣコーポレートカードの利用申込みにあたり、以下のとおり誓約いたします。"]
[]
[]
[null,null,"一．",null,"利用申込書及び添付書類に虚偽はないこと。"]
[]
[null,null,"一．",null,"「ＥＴＣコーポレートカード利用約款」に違反する行為は行わないこと。"]
[]
[null,null,"一．",null,"ＥＴＣコーポレートカード利用者に対して、「ＥＴＣコーポレートカード利用約款」の内容を周知徹底し、当該約款に違反する行為を行わないよう適切に指導すること。"]
[]
[null,null,"一．",null,"上記事項について、貴社から説明を求められた場合には、誠実に回答すること。"]
[null,null,null,null,"また、カード利用者（事業協同組合の場合は、組合員）から請求内容及び割引内容について説明を求められた場合には、誠実に回答すること。"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ご住所"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お名前",null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"未入力の項目があります｡確認し入力して下さい｡"]

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[null,"別記様式１（その４）"]
[]
[null,null,null,null,null,null,"ＥＴＣコーポレートカード利用申込書"]
[null,null,null,null,null,null,null,null,"（ＥＴＣコーポレートカード利用申込み車両一覧）"]
[]
["◆申込者内容（お名前・おところ等）"]
["区分（前）"]
["お名前"]
["区分（後）"]
["お名前（ふりがな）"]
["郵便番号"]
["おところ（都道府県）"]
["おところ（市区町村等）"]
["おところ（ビル名称等）"]
["電話番号"]
["申込カード枚数",null,null,null,null,null,null,null,{"$f":"新規1_その1!Q19","v":0}]
[]
["◆申込車両"]
["車両番号",null,null,null,null,null,null,null,null,null,null,null,"車載器管理番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"備考"]