| F1 | F2 | F3 | F4 | F5 | F6 | F7 | F8 | F9 | F10 | F11 | F12 | F13 | F14 | F15 | F16 | F17 | F18 | F19 | F20 | F21 | F22 | F23 | F24 |
| | BILL TO | | SHIP TO | | | | | | | | | | | | | | | | | | | | |
| Attn | Satoshi Fukanuma | Attn | PACKAGE INDIVIDUALLY - GOING TO DIFFERENT LOCATION | | | | | | | | | | | | | | | | | | | | |
| Company: | Iwai Tsusho K.K. - V 250 XED | Company: | Satoshi Fukanuma | | | | | | | | | | | | | | | | | | | | |
| Address: | 4-6, 5-Chrome | Address: | Iwai Tsusho K.K. - V 250 XED | | | | | | | | | | | | | | | | | | | | |
| | | | 4-6, 5-Chrome, Nishi-Nippori | | | | | | | | | | | | | | | | | | | | |
| | | | Arakawa-ku, Tokyo, 116-0013 | | | | | | | | | | | | | | | | | | | | |
| City/State/Zip: | Nishi-Nippori, Arakawa-ku Japan | City/State/Zip: | , Japan | | | | | | | | | | | | | | | | | | | | |
| Phone/Fax | 81-80-8491-9634 | Phone/Fax | 81-80-8491-9634 | | | | | | | | | | | | | | | | | | | | |
| Email | satoshi.fukanuma@gmail.com | Email | satoshi.fukanuma@gmail.com | | | | | | | | | | | | | | | | | | | | |