  <div class="mw_wp_form mw_wp_form_input">
    <form method="post" action="https://noblejapan.jp/hiroshima/contact/confirm" enctype="multipart/form-data">
      <table>
        <tbody>
          <tr>
            <th>資料請求 or お問合せ<span class="c-required">(必須)</span></th>
            <td>
              <span class="mwform-checkbox-field horizontal-item">
                <label >
                  <input type="checkbox" name="種類[]" value="資料請求">
                  <span class="mwform-checkbox-field-text">資料請求</span>
                </label>
              </span>
              <span class="mwform-checkbox-field horizontal-item">
                <label >
                  <input type="checkbox" name="種類[]" value="ブライダルフォトのお問合せ">
                  <span class="mwform-checkbox-field-text">ブライダルフォトのお問合せ</span>
                </label>
              </span>
              <span class="mwform-checkbox-field horizontal-item">
                <label >
                  <input type="checkbox" name="種類[]" value="レンタルスタジオのお問合せ">
                  <span class="mwform-checkbox-field-text">レンタルスタジオのお問合せ</span>
                </label>
              </span>
              <span class="mwform-checkbox-field horizontal-item">
                <label >
                  <input type="checkbox" name="種類[]" value="その他ご連絡">
                  <span class="mwform-checkbox-field-text">その他ご連絡</span>
                </label>
              </span>
            </td>
          </tr>
          <tr>
            <th>お名前<span class="c-required">(必須)</span></th>
            <td>
              <input type="text" name="お名前" class="c-textbox type-m" size="32" maxlength="32" value="" placeholder="例：山田太郎">
            </td>
          </tr>
          <tr>
            <th>フリガナ<span class="c-required">(必須)</span></th>
            <td>
              <input type="text" name="フリガナ" class="c-textbox type-m" size="32" maxlength="32" value="" placeholder="例：ヤマダタロウ">
            </td>
          </tr>
          <tr>
            <th>ご住所</th>
            <td>
              <p class="c-notes input-only">郵便番号</p>
              <div>〒
                <input type="text" name="郵便番号" class="c-textbox type-s p-postal-code" size="60" value="" placeholder="例：0123456">
                <span class="c-notes input-only">※ハイフンなし</span></div>
              <p>
                <input type="text" name="住所" class="c-textbox type-m p-region p-locality p-street-address p-extended-address" size="60" value="">
              </p>
              <p class="c-notes input-only">※資料請求される場合、郵便番号と住所は必ずご記入ください。</p>
            </td>
          </tr>
          <tr>
            <th>電話番号<span class="c-required">(必須)</span></th>
            <td>
              <input type="text" name="電話番号" class="c-textbox type-s" size="60" value="" placeholder="例：09012345678">
            </td>
          </tr>
          <tr>
            <th>メールアドレス<span class="c-required">(必須)</span></th>
            <td>
              <div>
                <input type="email" name="メールアドレス" class="c-textbox" size="60" maxlength="60" value="" placeholder="例：abcd@xxxxxx.com" data-conv-half-alphanumeric="true"/>
              </div>
              <p class="c-notes">確認用メールアドレス</p>
              <div>
                <input type="email" name="確認用メールアドレス" class="c-textbox" size="60" maxlength="60" value="" placeholder="例：abcd@xxxxxx.com" data-conv-half-alphanumeric="true"/>
              </div>
            </td>
          </tr>
          <tr>
            <th>撮影予定時期</th>
            <td>
              <select name="撮影予定年" class="c-select">
                <option value="" selected='selected'>
                年を選択    </option>
                                <option value="2026年">
                2026年   </option>
                                <option value="2027年">
                2027年   </option>
                                <option value="2028年">
                2028年   </option>
                                <option value="2029年">
                2029年   </option>
                              </select>

              <select name="撮影予定月" class="c-select">
                <option value="" >
                月を選択    </option>
                <option value="1月" >
                1月    </option>
                <option value="2月" >
                2月    </option>
                <option value="3月" >
                3月    </option>
                <option value="4月" >
                4月    </option>
                <option value="5月" >
                5月    </option>
                <option value="6月" >
                6月    </option>
                <option value="7月" >
                7月    </option>
                <option value="8月" >
                8月    </option>
                <option value="9月" >
                9月    </option>
                <option value="10月" >
                10月   </option>
                <option value="11月" >
                11月   </option>
                <option value="12月" >
                12月   </option>
              </select>
            頃</td>
          </tr>
          <tr>
            <th>お問合せ内容</th>
            <td>
              <textarea name="内容" class="c-textarea" cols="50" rows="6" ></textarea>
            </td>
          </tr>
        </tbody>
      </table>
      <div class="c-buttonGroup">
        <input type="submit" name="submitConfirm" value="入力内容の確認" class="c-button2">
      </div>
      <p class="p-form__toplink"><a href="/">TOPへ戻る</a></p>
    </form>
  </div><br />
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