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Digital Camera Accessory Order Form
Please photocopy this form when placing an order.
1. Digital Camera Model #
2. Items Ordered
A
c c
e
s s
o
y r
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.
F
r i
t s
Street Address
City
TO OBTAIN ANY OF OUR DIGITAL CAMERA ACCESSORIES YOU CAN DO ANY OF
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VQT5L14 (ENG)
#
D
e
c s
i r
t p
o i
n
Credit Card #
Expiration Date
Customer Signature
L
a
t s
VISIT YOUR LOCAL PANASONIC DEALER
YOU MAY CONTACT US DIRECTLY AT:
1-800-237-9080 (FAX ONLY)
MAIL THIS ORDER TO: PANASONIC NATIONAL PARTS CENTER
20421 84th Avenue South, Kent, WA 98032
r P
c i
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E
a
c
h
Quantity
Shipping & Handling
Your State & Local Sales Tax
State
Zip
THE FOLLOWING:
OR
OR
T
t o
l a
r P
$6.95
Subtotal
Total
Phone#:
(
)
Day
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)
Night
c i
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