General Inquiry Form | Contact | Mitsubishi Gas Chemical Company, Inc.

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After that, please press the "Confirm" button at the bottom of the page.</p> <div> <ul class="form-flow"> <li class="act"> <span class="num">1</span> <span>Form</span> </li> <li> <span class="num">2</span> <span>Confirmation</span> </li> <li> <span class="num">3</span> <span>Complete</span> </li> </ul> </div> <div><span class="icon-required">Required</span>fields must be filled out.</div> <form action="index.php" method="post" name="me_mailform" id="form" enctype="multipart/form-data"> <input type="hidden" name="_step" value="confirm"><input type="hidden" name="_token" value="a6a36e586e1ba181e4a0484af64160da00326cfa"><table class="table-default spaceMT" role="table" aria-label="General Inquiry Form Table" summary="General Inquiry Request Form Table"> <tbody> <tr> <th class="ttl" scope="row"><label for="komoku"><span class="icon-required">Required</span>Inquiry Subject<br> (Select all that apply)</label></th> <td> <select name="type"> <option value="">Please Select</option> <option value="Delivery of information to our product, service, etc.." >Delivery of information to our product, service, etc..</option> <option value="Other" >Other</option> </select> </td> </tr> <tr> <th class="ttl" scope="row"><label for="name"><span class="icon-required">Required</span>Name</label></th> <td><input type="text" name="name" id="name" value="" class="w45 sp-wMax"> <span class="form-textNote"></span> </td> </tr> <tr> <th class="ttl" scope="row"><label for="company"><span class="icon-required">Required</span>Company</label></th> <td><input type="text" name="company" id="company" value="" class="w45 sp-wMax"> <span class="form-textNote"></span> <p class="text-atn"></p> </td> </tr> <tr> <th class="ttl" scope="row"><label for="organicName"><span class="icon-any">Optional</span>Department</label></th> <td><input type="text" name="post" id="organicName" value="" class="w100"> <p class="text-atn"></p> </td> </tr> <tr> <th class="ttl" scope="row"><label for="country"><span class="icon-any">Optional</span>Country</label></th> <td><input type="text" name="country" id="country" value="" class="w45 sp-wMax"> </td> </tr> <tr> <th class="ttl" scope="row"><label for="state"><span class="icon-any">Optional</span>State or Province</label></th> <td><input type="text" name="state" id="state" value="" class="w45 sp-wMax"> </td> </tr> <tr> <th class="ttl" scope="row"><label for="local"><span class="icon-any">Optional</span>City</label></th> <td><textarea type="text" name="city" id="local"></textarea> </td> </tr> <tr> <th class="ttl" scope="row"><label for="street"><span class="icon-any">Optional</span>Street</label></th> <td><input type="text" name="street" id="street" value="" class="w45 sp-wMax"> </td> </tr> <tr> <th class="ttl" scope="row"><label for="postcode"><span class="icon-any">Optional</span>Zip or Postal code</label></th> <td><input type="text" name="zipcode1" id="postcode" value=""> </td> </tr> <tr> <th class="ttl" scope="row"><label for="phone"><span class="icon-required">Required</span>TEL</label></th> <td><input type="text" name="phone1" size="7" id="phone" value="" class="w25-Per"> - <input type="text" name="phone2" size="10" value="" class="w25-Per"> - <input type="text" name="phone3" size="10" value="" class="w25-Per"> </td> </tr> <tr> <th class="ttl" scope="row"><label for="fax"><span class="icon-any">Optional</span>FAX</label></th> <td><input type="text" name="fax1" size="7" id="fax" value="" class="w25-Per"> - <input type="text" name="fax2" size="10" value="" class="w25-Per"> - <input type="text" name="fax3" size="10" value="" class="w25-Per"> </td> </tr> <tr> <th class="ttl" scope="row"><label for="mail"><span class="icon-required">Required</span>E-mail address</label></th> <td><input type="text" name="email" id="mail" value="" class="w100"> </td> </tr> <tr> <th class="ttl" scope="row"><label for="question"><span class="icon-required">Required</span>Messages</label></th> <td><textarea name="comment" rows="5"></textarea> </td> </tr> </tbody> </table> <div class="box-colorD spaceLT"> <p>The personal information you provide will be used only to the extent necessary to respond to your inquiries based on your consent, and will not be used for any other purpose. Depending on the nature of the inquiry, the personal information you provide may be disclosed to relevant MGC Group companies, which may then respond directly to the inquiry. Also in such cases, the personal information you provide will be used only to the extent necessary to respond to your inquiries, and will not be used for any other purpose. For more information on MGC's policy on protection of personal information, please see the <a href="/eng/privacy/" class="inline">Privacy Policy</a>.<br>SSL (an encrypted transmission protocol) is used to ensure the secure transmission of the information entered on this inquiry form.</p> </div> <p class="form-checkbox spaceMT"> <input type="checkbox" name="agree" value="agree" id="agree" > <label for="agree"><span class="icon-required">Required</span>I accept the terms and conditions concerning the handling of personal information.</label> </p> <div class="confirmation-btn-area"> <div class="confirmation-btn"> <input type="submit" name="button btn-primary" id="button" value="Confirm" class="confirmation-icon"> </div> </div> <input name="actionMode" type="hidden" value="confirm"> </form> </section> </div>   <aside id="localMenu"> <nav> <dl> <dt class="lm-categoryTtl"><a href="/eng/inquiry/">Contact</a></dt> <dd> <ul class="lm-list"> <li><a href="/eng/inquiry/media/"><span>Media and Press Inquiries</span></a></li> <li><a href="/eng/inquiry/ir/"><span>Stock and Investors Inquiries</span></a></li> <li><a href="/eng/inquiry/request/"><span>Information Request Form</span></a></li> <li><a href="/eng/inquiry/division/"><span>Department Inquiry Form</span></a></li> <li><a href="/eng/corporate/compliance/contact.html">Compliance Hotline</a></li> <li><a href="/eng/sustainability/society/humanright/contact.html">Human Rights Hotline</a></li> <li><a href="/eng//inquiry/products/"><span>Product Inquiry</span></a></li> <li><a href="/eng/inquiry/other/"><span>General Inquiry Form</span></a></li> </ul> </dd> </dl> </nav> </aside>  </div>  </main> <footer id="footer"> <div id="footerArea">  <div class="contentsInner ftrInner"> <div id="ftrMenu-block" class="col-2 col-clm1-2"> <div id="ftr-logo"> <a href="/eng/"><img src="/eng/shared/img/ftr-logo.svg" alt="MGC Group logo"></a> <ul class="ftr-sns"> <li><a href="https://www.youtube.com/channel/UCRVaVQrnl8KbJD1hafPJ2ag" target="_blank"><img src="/eng/shared/img/youtube_icon.png" alt="youtube logo"></a></li> </ul> </div> <div id="ftrSubMenu"> <ul> <li><a href="/eng/sitemap.html">Sitemap</a></li> <li><a href="/eng/privacy/">Privacy Policy</a></li> <li><a href="/eng/sns_policy.html">MGC鈥檚 Social Media Policy</a></li> </ul> <ul> <li><a href="/eng/site.html">Terms of Use</a></li> <li><a href="/eng/accessibility.html">Web Accessibility Policy</a></li> </ul> </div> </div> </div>  <div id="ftr-copyright"><div class="contentsInner"><p>Copyright 漏 MITSUBISHI GAS CHEMICAL COMPANY, INC. 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General Inquiry Form | Contact | Mitsubishi Gas Chemical Company, Inc.