Accessor Y O R Der For M ( For U Sa And Puer T O R I Co C Ust Om Er S) - Panasonic HC-V100M Owner's Manual

A ccessor y O r der For m
Please photocopy this form when placing an order.
1. Model #
2. Items Ordered
Accessory # Description
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
I n C AN AD A, pl ease cont act your l ocal Panasoni c deal er f or m or e i nf or m at i on on
Accessor i es.
( For U SA and Puer t o R i co C ust om er s)
Price Each
Your State & Local Sales Tax
Credit Card #
Expiration Date
Customer Signature
Last
State Zip
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
[6 AM-6 PM M-F, PACIFIC TIME]
OR
20421 84th Ave. S., Kent, WA 98032
Quantity
Shipping & Handling
Subtotal
Total
Phone#:
Day ( )
Night ( )
Total Price
$6.95
121
VQ T3Y04