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[null,"双和化学産業株式会社　ポリルーフ事業部　殿",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"No."]
[]
[]
[null,null,"保証書",null,null,null,"出荷証明書",null,null,null,null,null,"証明書右上発行日付：",null,null,null,null,null,null,"年",null,"月",null,"日"]
[]
[null,"※チェックマークを入れてください"]
[]
["発　行　依　頼　書"]
[]
["送付先"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※　保証書発行の際は、すべての項目をご記入下さい。記入漏れがあった場合は発行が出来ませんのでご了承下さい。"]
[]
["〒",null,null,null,"-",null,null,null,null,null,null,null,null,"防水施工業者",null,null,null,null,null,null,null,null,null,"印"]
["住所"]
[]
[]
[]
["電話",null,null,null,"-",null,null,null,"-",null,null,null,null,"販売代理店",null,null,null,null,null,null,null,null,null,"印"]
[]
[]
["工　事　名　称"]
[]
["物 件 所 在 地"]
[]
["施　工　箇　所"]
[]
["工　　法　　名",null,null,null,null,null,null,null,"工法",null,null,null,null,"工法",null,null,null,null,"工法",null,null,null,null,"工法"]
[]
["面　　　　　積",null,null,null,null,null,null,null,"㎡",null,null,null,null,"㎡",null,null,null,null,"㎡",null,null,null,null,"㎡"]
[]
["保　証　年　数",null,null,null,null,null,null,null,"年",null,null,null,null,"年",null,null,null,null,"年",null,null,null,null,"年"]
[]
["工　事　期　間",null,null,null,null,null,null,"年",null,"月",null,"日","～",null,null,"年",null,"月",null,"日"]
[]
["保証開始日",null,null,null,"工事完成引渡日",null,null,null,null,null,"年",null,"月",null,"日","より"]
[]
["保証書・出荷証明書宛名",null,null,null,"(※施主・空欄は不可)"]
[]
[]
["元　　　　　請",null,null,null,null,null,null,null,null,null,null,null,"設 計 事 務 所"]
[]
["新築／改修",null,null,null,"1．新築　　２.改修",null,null,null,null,"官民区分",null,null,"１.中央官庁 　２.地方自治体　 ３.民間　 ４.その他"]
[]
["建　物　区　分",null,null,null,"１.一般ビル ２.マンション ３.木造住宅 ４.庁舎 ５.学校 ６.幼稚園 ７.病院 ８.駐車場　　"]
[null,null,null,null,"９.工場及び関連施設　１０.上下水道　１１.緑化",null,null,null,null,null,null,null,null,null,null,"１２.その他(",null,null,null,null,null,null,null,")"]
["使　用　目　的",null,null,null,"１.歩行 　２.非歩行 　３.駐車場(乗用車・大型車)　 ４.貯水 　５.耐薬品／耐食"]
[null,null,null,null,"６.その他(",null,null,null,null,null,null,null,null,")"]
["構　　　　　造",null,null,null,"１.S造　　２.RC　　３.SRC　　４.PC　　５.木造　　",null,null,null,null,null,null,null,null,null,"６.その他(",null,null,null,null,null,null,null,")"]
[]
["既　存　下　地",null,null,null,"１.モルタル、コンクリート　２.構造用合板　３.既存防水層　４.金属　５.タイル"]
[null,null,null,null,"６.その他(",null,null,null,null,null,null,null,null,")"]
["下地処理方法",null,null,null,"１高圧水洗　２.ポリッシャー又はサイディング　３.パテ処理　"]
[null,null,null,null,"４.樹脂モルタル(品名",null,null,null,null,null,null,null,null,")　(厚み",null,null,"ｍ/ｍ)",null,"５.その他(",null,null,null,null,")"]
["使　用　材　料\n※必ずご記入下さい",null,null,null,"品　　名",null,null,null,null,null,"ｋｇ・ｍ",null,"缶/本",null,"品　　名",null,null,null,null,null,"ｋｇ・ｍ",null,"缶/本"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
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[null,"※弊社施工に係る上記明細の防水工事に関して",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"部",null,"発行お願い致します。"]
[]
[null,"※保証書の締切りはPM２時までとなっております。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"部"]
[]
[null,"なお保証に関しましては、製品に対する保証のみで施工その他に関しては"]
[null,"一切のご迷惑をかけぬ事を誓約します。"]