Contact Us

Purenic Japan Inc .,

2492-2 Hokota Hokota-city Ibaraki Japan 311-1517

Tel +81.291327010 (English)

Tel +81.291327373 (Japanese)

Fax +81.291347374

Agent Register Form:

* Required fields.
Note: Please input into * fields with the correct information. It will be used in case you lost password or contact with you if you become our registrant.
Company Name(代理店名)*
Login ID*
Password* (6 to 16 characters)
Confirm Password*
Title(代表者役職) (E.g:Director,C.E.O,...)
Full Name(名前)* (E.g:Peter Parker, Eliz Parker,...)
Country(国)*
City*
Postal Code(郵便番号)
Address1(住所1)*
Address2(住所2)
TEL* (半角英数）(E.g:+84.12345678)
FAX* (半角英数）(E.g:+84.12345678)
Web Site (半角英数）
Email* (半角英数）
Note(備考)
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I have read and agreed all the terms of Purenic Reseller Agreement.
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