Accessory Order Form (For Usa Customers) - Panasonic HC-V180 Basic Owner's Manual

Accessory Order Form
Please photocopy this form when placing an order.
1. Model #
2. Items Ordered
Accessory #
3. Method of payment (check one)
American Express
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
In CANADA, please contact your local Panasonic dealer for more information on
Accessories.
30
SQT1126 (ENG)
Description
Credit Card #
Expiration Date
Customer Signature
Last
State
TO OBTAIN ANY OF OUR ACCESSORIES YOU CAN DO ANY OF
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
VISIT OUR WEBSITE AT:
http://shop.panasonic.com/
(For USA Customers)
Price Each Quantity
Shipping & Handling
Your State & Local Sales Tax
Phone#:
Day
Night (
Zip
OR
Total Price
$6.95
Subtotal
Total
( )
)