Digital Camera Accessory Order Form
Please photocopy this form when placing an order.
1. Model #
2. Items Ordered
Accessory #
Description
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 THE
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-272-7033 [8:30 AM-8 PM M-F, EST]
MAIL THIS ORDER TO: PANASONIC SERVICES COMPANY ACCESSORY ORDER OFFICE
Price Each
Your State & Local Sales Tax
Credit Card #
Expiration Date
Customer Signature
Make Check or Money Order to: MATSUSHITA ACCESSORIES
Last
State
Zip
FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
OR
20421 84th Avenue South Kent, WA. 98032
Quantity
Subtotal
Shipping & Handling
Total Enclosed
Phone #:
Day
(
)
Night
(
)
Total Price
5.00
81