Form transmission of reservation

* : indispensable input  # : Either is indispensable.

Reservation day*    Number of reservations*  
Type*  
Name*  
Sex  Male|Female
Zip-code*    Prefecture*  
Address*  
Telephone number#  
Mobile-phone number#  
Facsimile number  
Mail Address*  
Mail Address*   Please give me reinput for a check.
Communication column  

Please click the send button if it doesn't find the mistake in the input.