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[null,"別記様式１７"]
[]
[null,null,null,"ＥＴＣコーポレートカード組合員解約届"]
[]
[]
[null,"東日本高速道路株式会社",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,"殿"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"お客様番号",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,"お客様の",null,null,null,"〒",null,null,null,"‐"]
[null,null,null,null,null,null,null,null,null,null,null,null,"おところ"]
[]
[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,null,"印"]
[null,null,null,null,null,null,null,null,null,null,null,null,"ＴＥＬ",null,null,null,null,null,null,"‐",null,null,null,"‐"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"（※）",null,"事業協同組合名及び代表者名を記入してください。"]
[]
[]
[null,"ＥＴＣコーポレートカードの利用者である下記の組合員において、大口・多頻度割引制度における組合員としてカードの解約手続きを行うこととしたいので、下記のとおりＥＴＣコーポレートカードを添えて申し出いたします。"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記"]
[null,"① 組合員名"]
[]
[null,"　　組合員番号"]
[]
[null,"②返却するＥＴＣ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"枚"]
[null,"コーポレートカードの枚数"]
[null,null,null,null,null,null,null,null,null,"（始）",null,null,null,null,null,null,null,null,null,"（終）"]
[]
[]
[]
[]
[null,"③返却するＥＴＣ"]
[null,"コーポレートカードの番号"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"※窓口会社処理欄（お客さまはご記入しないで下さい。）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"解約年月日：",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[]
[null,"入力漏れチェック未了\r\n（「入力漏れチェック」を押してください。）"]