Digital Camera Accessory Order Form - Panasonic Lumix DMC-FX78 Basic Owner's Manual

Digital Camera Accessory Order Form

Please photocopy this form when placing an order.
1. Digital Camera 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 DIGITAL CAMERA 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
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
OR
[6 AM-6 PM M-F, PACIFIC TIME]
OR
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
Quantity
Subtotal
Shipping & Handling
Total Enclosed
Phone#:
Day (
(
Night
Zip
Total Price
6.95
)
)
31
(ENG) VQT3G16