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["四日市商工会議所　総務部　会員サービス課　行き"]
["ＦＡＸ　ＮＯ　０５９－３５４－３７３７"]
[]
[]
[{"$nulls":6},"令和　　年　　月　　日"]
[null,"四日市商工会議所　　御中"]
[{"$nulls":4},"依頼者"]
[{"$nulls":5},"所在地"]
[{"$nulls":5},"事業所名"]
[{"$nulls":5},"氏名","印"]
[]
["施設使用取消依頼書"]
[]
[null,"次の使用承認に係る使用の取消（備品等含む）をお願いいたします。"]
[]
[null,"申込日時","　令和　　　　年　　　　　月　　　　　日　（　　　　）"]
[null,"申込施設名","　１階　ホールⅠ",null,"午前","午後","夜間","全日"]
[null,null,"　１階　ホールⅡ",null,"午前","午後","夜間","全日"]
[null,null,"　３階　小会議室",null,"午前","午後","夜間","全日"]
[null,null,"　３階　中会議室",null,"午前","午後","夜間","全日"]
[null,null,"　３階　研修室",null,"午前","午後","夜間","全日"]
[null,null,"　４階　第２研修室",null,"午前","午後","夜間","全日"]
[null,"取り消し理由"]
[null,"連絡先","ＴＥＬ",null,null,"ＦＡＸ"]
[null,"担当者"]
[]
[null,"使用料・キャンセル料返金口座"]
[null,null,"銀行名",null,null,"支店名"]
[null,null,"預金種別","普通・当座",null,"口座番号"]
[null,null,"よみがな\n口座名義"]
[]
[null,"取消日が複数ある場合には、お手数ですが、本用紙をコピーしてください。"]
[]
[null,"当所使用欄","支払日"]