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Name
Address
Phone
Email
Age years (Please use single-byte numerals, e.g. 35.)
Occupation Company employee (non-management)
Company employee (management)
Government employee (non-management)
Government employee (management) Company executive
Self-employed (commercial) Physician
Attorney, tax advisor, accountant, etc. Educator
Self-employed (other) Not employed
Other
Annual income Up to ¥3 million Up to ¥5 million Up to ¥7 million
Up to ¥9 million Up to ¥12 million Up to ¥15 million
Up to ¥20 million Over ¥20 million
Preferred method of contact
Phone Email
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