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For reservation by e-mail, please fill the following form.

Have you used us before?※	Yes No
Use store※	--- GINZA ROPPONGI
Use date and time※	Use day --- 2009 2010 2011 / --- 1 2 3 4 5 6 7 8 9 10 11 12 / --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Use time zone --- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ： --- 00 30 ～ --- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 ： --- 00 30
Number of use※	--- 1 2 3 4 5 person
Option service	Meal Menu Breakfast Lunch Supper Next day's BF Sweets Option Menu diaper
Child's name※	Example ： Chikako Hanai
Child's sex※	Boy Girl
Date of birth※	--- 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 / --- 1 2 3 4 5 6 7 8 9 10 11 12 / --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 （Full years old）
Guardian's name※	Example ： Chikako Hanai
Phone number and E-mail※	Example ： Mobile ： 00-0000-0000, E-mail ： toiawase@kizz-hana-hana.jp Home Mobile E-mail
Address※	Example ： Address01 : Tokyo, Address02 : 7-15-18 Roppongi Minato-ku, Address03 : viradesut1F Address01 --- Hokkaido Aomori Iwate Miyazaki Akita Yamagata Fukushima Ibaragi Tochigi Gunma Saitama Chiba Tokyo Kanagawa Niigata Toyama Ishikawa Fukushima Yamanashi Nagano Gifu Shizuoka Aichi Mie Shiga Kyoto Osaka Hyougo Nara Wakayama Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Aichi Kouchi Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki Kagoshima Okinawa Address02 Address03
Comment	Example ： I want to make reservations for two days, but what will do?

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