document.write('<!--LP_FORM_START-->');
document.write('	<section class="area-form">');
document.write('		<h2>フレッツ光 提供エリアのご確認</h2>');
document.write('		<div class="wrap">');
document.write('				<div>');
document.write('					<p class="form-discription" style="text-align: center; font-weight: bold; color:#004d9a;">提供可能なエリアか確認し、専門スタッフがお電話にてご案内いたします。</p>');
document.write('				</div>');
document.write('		');
document.write('				<div class="flow-list-2 pcnone">');
document.write('					<p>簡単3ステップ</p>');
document.write('					<ol>');
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('				</div>');
document.write('		');
document.write('				<form method="post" name="sfm-form" id="sfm-form" action="//flets-hikari.com/west/area/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>');
document.write('								<input type="tel" id="postcode1" name="postcode1_s" size="10" maxlength="8" placeholder="例）1234567" value="">');
document.write('							</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 form_group">');
document.write('								<input type="hidden" name="usercontent_s" />');
document.write('								<input type="radio" id="usercontent_1" name="usercontent_s" value="新規お申し込み" />');
document.write('								<label class="form_radio" id="btn_formchoice_new" for="usercontent_1">新規お申し込み</label>');
document.write('								<input type="radio" id="usercontent-2" name="usercontent_s" value="引越し手続き" />');
document.write('								<label class="form_radio" id="btn_formchoice_move" for="usercontent-2">引越し手続き</label>');
document.write('								<input type="radio" id="usercontent-3" name="usercontent_s" value="他社からの乗り換え" />');
document.write('								<label class="form_radio" id="btn_formchoice_fromother" for="usercontent-3">他社からの乗り換え</label>');
document.write('								<input type="radio" id="usercontent-4" name="usercontent_s" value="その他" />');
document.write('								<label class="form_radio" id="btn_formchoice_other" for="usercontent-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>');
document.write('								<input class="text" type="text" name="name_s" id="name" size="30" placeholder="例）西日本 太郎" value=""/>');
document.write('							</td>');
document.write('						</tr>');
document.write('		');
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>');
document.write('								<input type="tel" name="tel_s" id="tel" placeholder="例）09012345678" value=""/>');
document.write('							</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>');
document.write('								<input type="email" name="mail_s" id="email" class="half-width" placeholder="例）example@flets-hikari.com" value="">');
document.write('');
document.write('							</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="【フレッツ光_西日本_夜間_PC】提供エリア確認メール" />');
document.write('					<!-- 注文番号 -->');
document.write('					<input type="hidden" name="orderid" id="orderid" value="20240430045118" />');
document.write('		');
document.write('					<div align="center">');
document.write('						<input type="hidden" name="action" value="conf" />');
document.write('						<input class="button alert 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('				<div id="cookie-data"></div>');
document.write('			</div>');
document.write('	</section>');
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>');