FUSION GOL for Business

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Company Name [Required]
Department Name
Contact Name [Required]
Postal Code [Required]	English one byte characters ex)1010054
Prefecture [Required]
Address 1 [Required]
Address 2
Phone Number [Required]	English one byte characters ex)0312345678
FAX Number	English one byte characters ex)0312345678
E-mail Address [Required]
Services	* Basic Services Broadband + IP-Phone - Single Line(ADSL/Fiber Optics) Broadband + IP-Phone - Multiple Lines(ADSL/Fiber Optics) Broadband (ADSL/Fiber Optics) Static IP on Broadband Web Hosting Service
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