document.write('<!--LP_FORM_START-->');
document.write('				<form class="area_form_wrap" method="post" name="sfm-form" id="sfm-form" class="h-adr" action="//au-hikkoshi.com/area/confirm.html">');
document.write('					<div class="area_form_head">');
document.write('						<h3>簡単<em>3</em>ステップ</h3>');
document.write('						<ul class="area_form_flow">');
document.write('							<li class="area_form_flow_entry">1. 入力</li>');
document.write('							<li class="area_form_flow_confirm">2. 確認</li>');
document.write('							<li class="area_form_flow_complete">3. 完了</li>');
document.write('						</ul>');
document.write('					</div>');
document.write('					<table class="area_form_table">');
document.write('						<tbody>');
document.write('							<tr class="required-radio">');
document.write('								<th>');
document.write('									<span class="required">必須</span>');
document.write('									<b>お問い合わせ内容</b>');
document.write('								</th>');
document.write('								<td>');
document.write('									<div class="input-group">');
document.write('										<input type="hidden" name="content_s" />');
document.write('										<input type="radio" id="content-1" name="content_s" value="auひかり" />');
document.write('										<label for="content-1" class="content">auひかり</label>');
document.write('										<input type="radio" id="content-2" name="content_s" value="スマートフォン・携帯電話" />');
document.write('										<label for="content-2" class="content">スマートフォン・携帯電話</label>');
document.write('										<input type="radio" id="content-3" name="content_s" value="でんき・ガス" />');
document.write('										<label for="content-3" class="content">でんき・ガス</label>');
document.write('									</div>');
document.write('								</td>');
document.write('							</tr>');
document.write('							<tr class="required-input">');
document.write('								<th>');
document.write('									<span class="required">必須</span>');
document.write('									<b>郵便番号</b>');
document.write('								</th>');
document.write('								<td>');
document.write('									<input type="number" id="postcode" name="postcode_s" size="7" maxlength="7" placeholder="例）1234567　※ハイフン不要" 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>');
document.write('									<span class="required">必須</span>');
document.write('									<b>お名前</b>');
document.write('								</th>');
document.write('								<td>');
document.write('									<input class="text" type="text" name="name_s" id="name" 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>');
document.write('									<span class="required">必須</span>');
document.write('									<b>携帯電話番号</b>');
document.write('								</th>');
document.write('								<td>');
document.write('									<input type="number" name="tel_s" id="tel" placeholder="例）09012345678　※ハイフン不要" 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>');
document.write('									<span class="required">必須</span>');
document.write('									<b>メールアドレス</b>');
document.write('								</th>');
document.write('								<td><input type="text" name="mail_s" id="email" class="half-width" placeholder="例）example@hikari-center.com" value="" /></td>');
document.write('							</tr>');
document.write('						</tbody>');
document.write('					</table>');
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="【auひかりの引っ越し手続き】提供エリアのお問い合わせ(PC)" />');
document.write('					<!-- 注文番号 -->');
document.write('					<input type="hidden" name="orderid" id="orderid" value="20240504113208" />');
document.write('					<input type="hidden" name="action" value="conf" />');
document.write('					<div class="text-center">');
document.write('						<input type="submit" name="submit" id="btn_areaform_1" class="submit button primary" onclick="window.onbeforeunload=null" value="入力内容を確認">');
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>');