Panasonic Viera Link HX-WA10 Owner's Manual page 200

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)
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
MAIL THIS ORDER TO: PANASONIC SERVICE AND TECHNOLOGY COMPANY
200
VQT3P35
Description Price Each
Your State & Local Sales Tax
Credit Card #
Expiration Date
Customer Signature
Last
State
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
[6 AM-6 PM M-F, PACIFIC TIME]
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
Quantity
Subtotal
Shipping & Handling
Total Enclosed
Phone#:
Day
Night
Zip
OR
OR
Total Price
6.95
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