{include file=header.html}

##

{$lang.owner_name}: |  | * {$lang.note_for_owner_name}
{$lang.owner_card}: |  | {$lang.note_for_owner_card}
{$lang.store_name}: |  | * {$lang.note_for_store_name}
{$lang.store_category}: |  |
{$lang.region}: | {if $store.region_name} {$store.region_name|escape} {/if} |
{$lang.address}: |  |
{$lang.zipcode}: |  |
{$lang.tel}: |  | * {$lang.input_tel}
{$lang.upload_image}: | {if $store.image_1} {$lang.view} {/if} | {$lang.note_for_image}
{$lang.upload_permit}: | {if $store.image_2} {$lang.view} {/if} | {$lang.note_for_image}
{$lang.notice} |

{include file=footer.html}