{"id":1243,"date":"2022-10-04T17:31:28","date_gmt":"2022-10-04T08:31:28","guid":{"rendered":"https:\/\/www.gotoku.co.jp\/wordpress\/?page_id=1243"},"modified":"2025-04-07T16:51:59","modified_gmt":"2025-04-07T07:51:59","slug":"sample-request","status":"publish","type":"page","link":"https:\/\/www.gotoku.co.jp\/en\/sample-request\/","title":{"rendered":"Sample Request"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Sample Request<\/h2>\n\n\n\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1258-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"1258\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1243#wpcf7-f1258-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1258\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.2.3\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1258-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:1258,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;other_address_group&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;other_address&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Sample delivery address (Please fill in if you would like to use  other address than the previous)&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p>Product: <span class=\"wpcf7-form-control-wrap\" data-name=\"product-name\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"product-name\" value=\"E.C.G-505\u00ae (Japanese Pharmacopoeia Standards)\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">E.C.G-505\u00ae (Japanese Pharmacopoeia Standards)<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"product-name\" value=\"NS-300\u00ae (Japanese Pharmacopoeia Standards)\" \/><span class=\"wpcf7-list-item-label\">NS-300\u00ae (Japanese Pharmacopoeia Standards)<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>Usage: <span class=\"wpcf7-form-control-wrap\" data-name=\"usage\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"usage\" value=\"Pharmaceutical\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Pharmaceutical<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"usage\" value=\"Others\" \/><span class=\"wpcf7-list-item-label\">Others<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Specific purpose of use: <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"specific-purpose\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"specific-purpose\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Preferred date (please enter the desired date): <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"enter-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"{DD-MM-YYYY}\" type=\"date\" name=\"enter-date\" \/><\/span><\/label>\n<\/p>\n<p><label> Company Name: <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"company-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Department Name: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"department-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"department-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Contact Name: <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Address: <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"company-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company-address\" \/><\/span> <\/label>\n<\/p>\n<p><label> E-mail: <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label>Phone no: <small class=\"text-danger\">[required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-telephone\" \/><\/span> <\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"other_address\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"other_address[]\" value=\"Sample delivery address (Please fill in if you would like to use  other address than the previous)\" \/><span class=\"wpcf7-list-item-label\">Sample delivery address (Please fill in if you would like to use  other address than the previous)<\/span><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"other_address_group\" data-orig_data_id=\"other_address_group\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t<p><label> Company Name: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"company-name2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company-name2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Department Name: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"department-name2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"department-name2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Contact Name: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-name2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-name2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> Address: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"company-address2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company-address2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label> E-mail: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-email2\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label>Phone no: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-telephone2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-telephone2\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<p><label> Other requests: <small class=\"text-danger\"><\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"other-requests\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other-requests\"><\/textarea><\/span> <\/label>\n<\/p>\n<p>No confirmation screen is displayed. Do you agree to send the above contents? <small class=\"text-danger\"> [required]<\/small><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"confirmation\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"confirmation[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><\/span><\/span>\n<\/p>\n<p class=\"center\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner btn btn-primary btn-lg btn-block\" type=\"submit\" value=\"Submit\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Sample Request<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_editorskit_title_hidden":false,"_editorskit_reading_time":1,"_editorskit_is_block_options_detached":false,"_editorskit_block_options_position":"{}","_monsterinsights_skip_tracking":false,"_locale":"en_US","_original_post":"https:\/\/www.gotoku.co.jp\/wordpress\/?page_id=1243","sns_share_botton_hide":"","vkExUnit_sns_title":"","_vk_print_noindex":"","sitemap_hide":"","vkExUnit_sitemap":"","_veu_custom_css":"","veu_display_promotion_alert":"common","_exclude_from_list_pages":"","vkexunit_cta_each_option":"","vkExUnit_childPageIndex":"","vkExUnit_pageList_ancestor":"","vkExUnit_contact_enable":"","_lightning_design_setting":{"layout":"default"},"footnotes":""},"class_list":["post-1243","page","type-page","status-publish","hentry","en-US"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 5.0.3 - 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