document.write('<!--LP_FORM_START-->');
document.write('						<form  method="post" name="sfm-form" id="sfm-form" class="h-adr" action="//hikari-fiber.com/flets/west/area/confirm.html">');
document.write('							<div class="wrap">');
document.write('								<table class="form-table">');
document.write('									<tbody>');
document.write('										<tr class="required-input">');
document.write('											<th class="required-input">郵便番号 <span class="required">必須</span></th>');
document.write('											<td>');
document.write('												<input type="text" inputmode="numeric" id="postcode" name="postcode_s" size="7" maxlength="7" placeholder="例）1234567" value="">');
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document.write('										<tr class="required-input">');
document.write('											<th>お名前 <span class="required">必須</span></th>');
document.write('											<td><input class="text" type="text" name="name_s" id="name" size="30" placeholder="例）引越 太郎" value="" /></td>');
document.write('										</tr>');
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document.write('											<th>携帯電話番号 <span class="required">必須</span></th>');
document.write('											<td>');
document.write('												<input type="number" name="tel_s" id="tel" placeholder="例）09012345678" value="" />');
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><input type="text" name="mail_s" id="email" class="half-width" placeholder="例）mail@hikari-fiber.com" value="" /></td>');
document.write('										</tr>');
document.write('									</tbody>');
document.write('								</table>');
document.write('							</div>');
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="【光ファイバー.com_フレッツ光・西日本_夜間_pc】提供エリア確認メール" />');
document.write('							<!-- 注文番号 -->');
document.write('							<input type="hidden" name="orderid" id="orderid" value="20240506020547" />');
document.write('							<input type="hidden" name="action" value="conf" />');
document.write('							<div class="button-wrap">');
document.write('								<input type="submit" name="submit" id="btn_form_area_1" class="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>');