Accessory Order Form (For Usa And Puerto Rico Customers) - Panasonic HX-A100D Basic Owner's Manual

Accessory Order Form (For USA and
Puerto Rico Customers)
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
TO OBTAIN ANY OF OUR ACCESSORIES YOU CAN DO ANY OF
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-5368
MAIL THIS ORDER TO: PANASONIC NATIONAL PARTS CENTER
In CANADA, please contact your local Panasonic dealer for more information on Accessories.
Description Price Each
Credit Card #
Expiration Date
Customer Signature
Last
State
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
[6 AM-6 PM M-F, PACIFIC TIME]
20421 84th Ave. S., Kent, WA 98032
Quantity
Shipping & Handling
Subtotal
Your State & Local Sales Tax
Phone#:
Day
Night
Zip
OR
OR
Total Price
$6.95
Total
( )
( )
33
VQT4X87