About This Form

You can make a request to reissue your convenience store payment slip.

The reissued slip will be sent to your registered address by postal mail.

If your registered address has been changed due to moving (or any other reasons), please make the reissuance request after you change your address on My Page.

See the following page for details on precautions for reissuance.
Member Support: Convenience Store Payment Slip

The Required fields are mandatory.

Member Information

E.g., ab4t-ash

E.g., Asahi, Taro

E.g., January 01, 1990

E.g., 03-1234-5679

Address

E.g., Chuo-ku, Ginza

E.g., 4-12-15

E.g., KABUKIZA TOWER 21F

Request Information

Precautions for reissuance

*If you have passed the payment due date and make a request to reissue your payment slip, your subscription service may be suspended before you receive the reissued payment slip. Please be aware that it requires several business days to restart the service after you make your payment.

*If you have passed the payment due date and you wish your convenience store payment slip to be reissued, the slip cannot be reissued just before the date of service suspension. Please make your payment after the service is suspended using the convenience payment slip resent from Asahi Net.

Contact Information

例)asahi.taro@asahi-net.jp

 

Asahi Net, Inc. shall handle customers’ personal information appropriately in accordance with the Handling of Personal Information. Please read and give consent to the policy below.

Asahi Net, Inc. Handling of Personal Information

The purpose of use of personal information collected in this request procedure falls under the following category specified in the Handling of Personal Information.
(i) Personal information of customers under 2. Purpose of use.I agree to the Handling of Personal Information.

Handling of Personal Informationrequired
Your input data will be encrypted during transmission.