Panasonic Digital Palmcoder PV-DV103 Operating Instructions Manual page 52

Please photocopy this form when placing an order.
1, Palmcerder Mode_ #
2. {terns Ordered
Accessory # Description Price Each Quantity Total Price
3, Method of payment (check one)
[]
[]
[]
[]
Subtotal
Your State & Leca} Sales Tax
Shipping & Handling
Total Enclosed
6.95
Check of Money Order enclosed (NO C.O.D.SHIPMENTS)
ViSA Credit Card #
MasterCard Expiration Date
Discover Customer Signature
Make Check or Money Order to: PANASONIC ACCESSORIES
(Please de not send cash)
4. Shipping information (UPS delivery requires complete street address)
Ship To:
Mr.
Mrs.
Ms.
First
Last Phone #;
Day ( )
Street Address
Night ( )
City State Zip
TO OBTAIN ANY OF OUR PALMCORDER ACCESSORIES YOU CAN [30 ANY OF THE
FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
CALL PANASONIC'S ACCESSORY ORDER LINE AT t-800_332-5368
[6 AM-5 PM M-F, 6 AM-10:30 AM SAT, PACIFIC TIME]
OR
MAIL THIS ORDER TO: PANASONIC SERVICES COMPANY ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA, 98032
52