document.write('<!--LP_FORM_START-->');
document.write('					<form method="post" name="sfm-form" id="sfm-form" action="//move.au-kddi.com/area/confirm.html">');
document.write('						<table class="form-table">');
document.write('							<tr class="required-input">');
document.write('								<th>お申し込み内容 <span class="required">必須</span></th>');
document.write('								<td>');
document.write('									<select id="content" name="content_s" class="w220">');
document.write('										<option value="" selected="selected">選択してください </option>');
document.write('										<option value="auひかりの引越し手続き" >auひかりの引越し手続き</option>');
document.write('										<option value="スマホの引越し手続き" >スマホの引越し手続き</option>');
document.write('										<option value="でんき・ガスの引越し手続き" >でんき・ガスの引越し手続き</option>');
document.write('									</select>');
document.write('									<div class="ERR" style="font-weight:bold;"></div>');
document.write('								</td>');
document.write('							</tr>');
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 name="postcode1_s" id="postcode1" type="text" inputmode="numeric" maxlength="7" size="10" placeholder="例）1234567" autocomplete="postal-code" value="">');
document.write('									<div class="ERR" style="font-weight:bold;"></div>');
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 type="text" name="name_s" id="name" class="text" size="30" placeholder="例）東京太郎" value="" />');
document.write('									<div class="ERR" style="font-weight:bold;"></div>');
document.write('								</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('									<input type="tel" name="tel_s" id="tel" placeholder="例）09012345678" value="" />');
document.write('									<div class="ERR" style="font-weight:bold;"></div>');
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@au-kddi.com" value=""/>');
document.write('									<div class="ERR" style="font-weight:bold;"></div>');
document.write('								</td>');
document.write('							</tr>');
document.write('						</table>');
document.write('						<input type="hidden" name="subject" value="【AU1st_G_SP_全国_夜間_auひかり_個人_引越_メイン】提供メール" />');
document.write('						<input type="hidden" name="orderid" id="orderid" value="250606-211829" />');
document.write('						<input type="hidden" name="action" value="conf" />');
document.write('');
document.write('						<div align="center">');
document.write('							<input type="submit" name="submit" id="btn_form_area_1" class="button alert click" value="提供エリアを確認">');
document.write('						</div>');
document.write('					</form>');
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>');