From:[mail]
To:kazu@seina.nana.or.jp
Subject:INPUT_OFFER
MIME-Version: 1.0
Content-Type: text/plain; charset=ISO-2022-JP
Content-Transfer-Encoding: 7bit

========顧客情報============
顧客様　お名前:[end_user]

顧客様　住所:[addres]
顧客様　電話番号:[required-tel]

========特約店============
特約店名:[tokutaku]
ご担当者:[tantou]
E-mail:[required-mail]

========所見=============
[NO1]
[NO2]
[NO3]

========ＯＳ=============
[NO]

========症状=============
その他：[free]