Accessory Order Form - Panasonic VDR-D105 Operating Instructions Manual

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
Make Check or Money Order Payable to: PANASONIC ACCESSORIES
(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
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 ORDER OFFICE
P rice Each
Your State & Local Sales Tax
Credit Card #
Expiration Date
Customer Signature
Last
State Zip
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
OR
20421 84th Avenue South Kent, WA. 98032
Quantity
Subtotal
Shipping & Handling
Total Enclosed
Phone#:
Day (
Night (
Optional accessories
Total Price
6.95
)
)
99
LSQT1040