document.write('<!--LP_FORM_START-->');
document.write('	<div class="section_area area-form">');
document.write('');
document.write('		<div class="area-form-inner">');
document.write('			<ol class="flow-list pcnone">');
document.write('				<li class="active">入力</li>');
document.write('				<li>確認</li>');
document.write('				<li>完了</li>');
document.write('			</ol>');
document.write('	');
document.write('			<h1 id="confirm">フレッツ光 提供エリア 確認フォーム <span class="form_step">確認</span></h1>');
document.write('			<p>入力した内容をご確認ください。<br />');
document.write('			必須項目で未入力の項目がある場合は「戻る」ボタンを押して、入力画面に戻り、再度、ご入力ください。</p>');
document.write('		</div>');
document.write('');
document.write('		<form method="post" name="sfm-form" id="sfm-form" action="//flets-hikari.com/east/business/area_form/confirm.html">');
document.write('			<table class="form-table">');
document.write('				<tr class="required-input">');
document.write('					<th>郵便番号 <span class="required">必須</span></th>');
document.write('					<td><input type="text" inputmode="numeric" id="postcode1" name="postcode1_s" size="10" maxlength="8" placeholder="例）1234567" value=""></td>');
document.write('				</tr>');
document.write('				<tr class="required-radio">');
document.write('					<th>お手続き内容 <span class="required">必須</span></th>');
document.write('					<td>');
document.write('						');
document.write('					<div class="input-group">');
document.write('						<input type="hidden" name="procedure_s">');
document.write('						<input type="radio" id="type-1" name="procedure_s" value="新規お申し込み" >');
document.write('						<label for="type-1">新規お申し込み</label>');
document.write('						<input type="radio" id="type-2" name="procedure_s" value="引越し手続き" >');
document.write('						<label for="type-2">引越し手続き</label>');
document.write('						<input type="radio" id="type-3" name="procedure_s" value="他社からの乗り換え" >');
document.write('						<label for="type-3">他社からの乗り換え</label>');
document.write('						<input type="radio" id="type-4" name="procedure_s" value="その他" >');
document.write('						<label for="type-4">その他</label>');
document.write('					</div>						');
document.write('						');
document.write('					</td>');
document.write('				</tr>');
document.write('				<tr class="required-input">');
document.write('					<th>お名前 <span class="required">必須</span></th>');
document.write('					<td><input class="text" type="text" name="name_s" id="name" size="30" placeholder="例）東日本 太郎" value=""></td>');
document.write('				</tr>');
document.write('				<tr class="required-input">');
document.write('					<th>携帯電話番号 <span class="required">必須</span></th>');
document.write('					<td><input type="tel" name="tel_s" id="tel" placeholder="例）09012345678" value=""></td>');
document.write('				</tr>');
document.write('				<tr class="required-input">');
document.write('					<th>メールアドレス <span class="required">必須</span></th>');
document.write('					<td><input type="email" name="mail_s" id="email" class="half-width" placeholder="例）example@flets-hikari.com" value=""></td>');
document.write('				</tr>');
document.write('			</table>');
document.write('');
document.write('			<!-- PC / スマホアクセスを判別（メール件名振り分け） -->');
document.write('			<input type="hidden" name="subject" value="【FLE_G_SP_東日本_日中_フレッツ光_法人_単体_None】提供メール" />');
document.write('			<!-- 注文番号 -->');
document.write('			<input type="hidden" name="orderid" id="orderid" value="250425-180957" />');
document.write('');
document.write('			<div align="center">');
document.write('				<input type="hidden" name="action" value="conf" />');
document.write('				<input class="button alert submit click" id="btn_area" type="submit" name="submit" value="提供エリアを確認" />');
document.write('				<!--<input type="reset" name="reset" value="リセット" />-->');
document.write('			</div>');
document.write('		</form>');
document.write('		');
document.write('		<div id="cookie-data"></div>');
document.write('');
document.write('	</div>');
document.write('	');
document.write('<script>');
document.write('var lpQuery = location.search;');
document.write('var element = document.forms[0]; ');
document.write('element.action = element.getAttribute(\'action\')+lpQuery;');
document.write('</script>');