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Accessory Order Form
Please photocopy this form when placing an order.
1. Model #
2. Items Ordered
Accessory #
3.Method of payment (check one)
Check of Money Order enclosed (NO C.O.D.SHIPMENTS)
VISA
Credit Card #
MasterCard Expiration Date
Discover
Customer Signature
Make Check or Money Order Payable to: PANASONIC ACCESSORIES
(Please do not send cash)
4. Shipping information (UPS delivery requires complete street address)
Ship To:
Mr.
Mrs.
Ms.
First
Street Address
City
TO OBTAIN ANY OF OUR ACCESSORIES YOU CAN DO ANY OF
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-5368
MAIL THIS ORDER TO: PANASONIC SERVICE AND TECHNOLOGY COMPANY
In CANADA, please contact your local Panasonic dealer for more information
on Accessories.
Description
Price Each
Your State & Local Sales Tax
Last
State
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
[6 AM-6 PM M-F, PACIFIC TIME]
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
(For USA and Puerto Rico Customers)
Quantity
Subtotal
Shipping & Handling
Total Enclosed
Phone#:
Day
Night
Zip
OR
OR
Total Price
6.95
(
)
(
)
111
LSQT1426
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