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Please photocopy this form when placing an order.
1. SD Media Storage Model #
2. Items Ordered
Accessory #
3. Method of payment (check one)
Check or 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 SD MEDIA STORAGE ACCESSORIES YOU CAN DO ANY OF
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-5368
[6 AM-5 PM M-F, 6 AM-10:30 AM SAT, PACIFIC TIME]
MAIL THIS ORDER TO: PANASONIC SERVICES COMPANY ACCESSORY
Accessory Order Form
Description
Price Each
Your State & Local Sales Tax
Credit Card #
Expiration Date
Customer Signature
Make Check or Money Order to: PANASONIC ACCESSORIES
Last
State
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
Quantity
Subtotal
Shipping & Handling
Total Enclosed
Phone #:
Day (
Night (
Zip
OR
OR
Total Price
6.95
)
)
57
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