document.write('<!--LP_FORM_START-->');
document.write('		<form  method="post" name="form" id="sfm-form" class="h-adr" action="//hikari-center.com/area/confirm.html">');
document.write('			<table class="form-table">');
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 type="tel" id="postcode1" name="postcode1_s" pattern="[0-9]*" size="10" maxlength="8" placeholder="例）1234567" value="">');
document.write('						<div class="ERR" style="font-weight:bold;"></div>');
document.write('					</td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<th>住居タイプ <span class="required">必須</span></th>');
document.write('					<td>');
document.write('						<select name="building_s" id="building">');
document.write('							<option value="戸建て" >戸建て（3戸以下の建物）</option>');
document.write('							<option value="集合住宅" >集合住宅（4戸以上の建物）</option>');
document.write('						</select>');
document.write('						<div class="ERR" style="font-weight:bold;"></div>');
document.write('					</td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<th>導入予定時期 <span class="required">必須</span></th>');
document.write('					<td>');
document.write('						<select name="term_s" id="term">');
document.write('							<option value="直近（2週間以内）" >直近（2週間以内）</option>');
document.write('							<option value="1ヶ月以内" >1ヶ月以内</option>');
document.write('							<option value="2ヶ月以内" >2ヶ月以内</option>');
document.write('							<option value="3ヶ月以降" >3ヶ月以降</option>');
document.write('							<option value="未定" >未定</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>お名前 <span class="required">必須</span></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>携帯電話番号 <span class="required">必須</span></th>');
document.write('					<td>');
document.write('						<input type="tel" name="tel_s" id="tel" pattern="[0-9]*" placeholder="例）09012345678" value="" />');
document.write('						<div class="ERR" style="font-weight:bold;"></div>');
document.write('					</td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<th>メールアドレス <span class="any">任意</span></th>');
document.write('					<td>');
document.write('						<input type="email" name="mail" id="mail" class="half-width" pattern="[a-z0-9._%+-]+@[a-z0-9.-]+\.[a-z]{2,3}$" placeholder="例）example@hikari-center.com" value="" />');
document.write('					</td>');
document.write('				</tr>');
document.write('			</table>');
document.write('');
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="【光受付窓口】提供エリアフォームからお問い合わせ（PC）" />');
document.write('			<!-- 注文番号 -->');
document.write('			<input type="hidden" name="orderid" id="orderid" value="20250130160804" />');
document.write('			<input type="hidden" name="reply_tel" id="orderid" value="0120-122-136" />');
document.write('			<div align="center">');
document.write('				<input type="hidden" name="autoReply" value="受け取ります" />');
document.write('				<input type="hidden" name="mailToNum" value="0" />');
document.write('				<input type="hidden" name="action" value="conf" />');
document.write('				<input class="button click confirm" id="btn_to_comfirm" type="submit" name="submit" value="提供エリアを確認" onclick="window.onbeforeunload=null" />');
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>');