Digital Camera Accessory Order Form (For Usa Customers) - Panasonic Lumix DMC-LX100 Owner's Manual

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Digital Camera Accessory Order Form
(For USA Customers)
Please photocopy this form when placing an order.
1. Digital Camera 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 DIGITAL CAMERA ACCESSORIES YOU CAN DO ANY OF
MAIL THIS ORDER TO: PANASONIC NATIONAL PARTS CENTER
96
SQT0359 (ENG)
Description Price Each
Credit Card #
Expiration Date
Customer Signature
Last
State
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
YOU MAY CONTACT US DIRECTLY AT:
1-800-237-9080 (FAX ONLY)
20421 84th Avenue South, Kent, WA 98032
Quantity
Shipping & Handling
Subtotal
Your State & Local Sales Tax
Zip
OR
OR
Total Price
$6.95
Total
Phone#:
( )
Day
Night
( )