document.write('<!--LP_FORM_START-->');
document.write('		<div class="sec_head">');
document.write('			<h1 id="entry" class="sec_ttle"><span>Webお申し込み</span>フォーム</h1>');
document.write('		</div>');
document.write('		<div class="sec_body">');
document.write('			<div class="form-new_container">');
document.write('				<ol class="form-new_flow pcnone">');
document.write('					<li class="active">1</li>');
document.write('					<li>2</li>');
document.write('					<li>3</li>');
document.write('				</ol>');
document.write('				<form method="post" name="sfm-form" id="sfm-form" action="//flets-hikari.com/east/cross2/applytoppage/confirm.html">');
document.write('				<h2>ご契約者情報</h2>');
document.write('				<table class="form-new_table">');
document.write('					<tr class="required-input">');
document.write('						<th>お名前 <span class="required">必須</span></th>');
document.write('						<td><span class="checked-inner"><input class="text" type="text" name="name_s" id="name" size="30" placeholder="例）東日本 太郎" value=""><div class="check-img"><img src="/east/cross2/template/img/checkbox-icon.png" alt="" width="18" height="18"></div></span></td>');
document.write('					</tr>');
document.write('					<tr class="required-input">');
document.write('						<th>電話番号 <span class="required">必須</span></th>');
document.write('						<td>');
document.write('							<span class="checked-inner">');
document.write('								<input type="tel" name="tel_s" id="tel" placeholder="例）09012345678" value="">');
document.write('								<div class="check-img"><img src="/east/cross2/template/img/checkbox-icon.png" alt="" width="18" height="18"></div>');
document.write('							</span>');
document.write('						</td>');
document.write('					</tr>');
document.write('					<tr class="required-input">');
document.write('						<th>連絡希望時間 <span class="required">必須</span></th>');
document.write('						<td class="select-box">');
document.write('							<span class="checked-inner">');
document.write('								<select id="time_s" name="time_s" class="">');
document.write('									<option value="" selected="selected">選択してください</option>');
document.write('								');
document.write('									<option value="指定しない" >指定しない</option>');
document.write('									<option value="午前中" >午前中</option>');
document.write('									<option value="12時～15時" >12時～15時</option>');
document.write('									<option value="15時～18時" >15時～18時</option>');
document.write('									<option value="18時以降" >18時以降</option>');
document.write('								</select>');
document.write('								<div class="check-img"><img src="/east/cross2/template/img/checkbox-icon.png" alt="" width="18" height="18"></div>');
document.write('							</span>');
document.write('							<div class="ERR" ></div>');
document.write('						</td>');
document.write('					</tr>');
document.write('				</table>');
document.write('				<h2 class="form-new_ttle">フレッツ光ご利用住所</h2>');
document.write('					<table class="form-new_table">');
document.write('						<tr class="required-input">');
document.write('							<th>郵便番号 <span class="required">必須</span></th>');
document.write('							<td>');
document.write('								<span class="checked-inner sp-fit postcode-wrap">');
document.write('									<input type="text" inputmode="numeric" id="postcode1" name="postcode1_s" size="10" maxlength="7" placeholder="例）1234567" class="trigger" data-target="address" autocomplete="postal-code" value="">');
document.write('									<div class="check-img"><img src="/east/cross2/template/img/checkbox-icon.png" alt="" width="18" height="18"></div>');
document.write('								</span>');
document.write('								<span class="instruction">※ハイフン不要。</span>');
document.write('							</td>');
document.write('						</tr>');
document.write('					</table>');
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_夜間_フレッツ光_個人_単体_サブ】通常メール" />');
document.write('					<!-- 注文番号 -->');
document.write('					<input type="hidden" name="orderid" id="orderid" value="260404-062217" />');
document.write('		');
document.write('					<div align="center">');
document.write('						<!--<input class="button" type="image" src="image/btn_form.gif" alt="確認" /><br />-->');
document.write('						<input type="hidden" name="action" value="conf" />');
document.write('						<input class="button confirm" type="submit" name="submit" id="btn_apply_confirm_toppage" value="確認画面へ進む" />');
document.write('						<!--<input type="reset" name="reset" value="リセット" />-->');
document.write('					</div>');
document.write('					<div class="pcnone">');
document.write('						<div class="rapidssl">');
document.write('							<img src="../template/img/RapidSSL_SEAL-90x50.gif" style="margin-right: 5px; float: left;" alt="RapidSSL" />お客様の情報はSSL暗号化通信により保護されています。安心してご利用ください。');
document.write('						</div>');
document.write('					</div>');
document.write('				</form>');
document.write('			</div>');
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>');