Accessory Order Form (For Usa Customers) - Panasonic Palmcorder VDR-D50P Operating Instructions Manual

Accessory Order Form (For USA Customers)

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
MasterCard
Discover
(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 THE FOLLOWING:
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.
110
LSQT1319
Description P rice Each
Credit Card #
Expiration Date
Customer Signature
Make Check or Money Order Payable to: PANASONIC ACCESSORIES
Last
State
VISIT YOUR LOCAL PANASONIC DEALER
[6 AM-6 PM M-F, PACIFIC TIME]
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
Quantity
Subtotal
Your State & Local Sales Tax
Shipping & Handling
Total Enclosed
Phone#:
Day
Night
Zip
OR
OR
Total Price
6.95
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