International Student Exchange Dormitory
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J-DREAM APPLICATION FOR ADMISSION
RESERVATION CENTER TEL£º03-5827-3553 | FAX£º03-5827-3533
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By submitting this application we assume you have read and accepted J-DREAM's rules for its facilities.
DATE OF APPLICATION Date Month Year
NAME MALE FEMALE
NATIONALITY DATE OF BIRTH Date Month Year
TABLEWARE \2,000 BEDDING \7,000 PICK UP
Yes No Yes No Yes( A B No
DORMITORY NAME
( ROOM TYPE: )
CONTRACT TERM (IN MONTHS) :
DATE OF ENTRY Date Month Year ( FLIGHT#£©ARRIVAL TIME£º
SCHOOL NAME PERSON IN CHARGE
AGENT NAME PERSON IN CHARGE
APPLICANT
NAME :
TEL :
RELATION TO APPLICANT
¡Ù IF THIS APPLICATION HAS BEEN FILLED OUT BY ANOTHER PERSON ON YOUR BEHALF, WE WILL STILL CONSIDER THAT YOU HAVE AGREED TO ACCEPT J-DREAM REGULATIONS..
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¡Ø Arrival time must be: 9:00¢¦20:00 (From Monday¢¦Friday); 9:00¢¦17:00 (Saturday).
¡Ø Your room will be secured when your remittance is confirmed.
If you cancel your reservation due personal reasons, the money remitted will not be refunded.
¡Ø Please send us the bill of remittance with name of the remitter via fax after your remittance.
¡Ø¡¡In principle, payments cannot be refunded once you have signed the contract.
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If you are IN JAPAN Wire Transfer in Japanese Yen payable to:
Name Of Bank The Bank of Tokyo-Mitsubishi UFJ,Ltd / Kaminarimon Branch
Account number Regular savings account 0747208
Account Name M and S
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If you are abroad Wire Transfer in Japanese Yen payable to:
Name Of Bank The Bank of Tokyo-Mitsubishi UFJ,Ltd / Kaminarimon Branch
Account number Regular savings account 0747208
Account Name M and S
¡Ø¡¡For group pick up at the airport, your flight should arrive at the airport before 17:00 o'clock.
¡Ø Please refer to our brochure and website for detailed information.
¡Ø¡¡J-DREAM home page: http£º//www.j-dream22.com