Accessory Order Form (For Usa Customers) - Panasonic HX-A1M Basic Owner's Manual

Accessory Order Form
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
YOU MAY CONTACT US DIRECTLY AT: 1-800-237-9080 (FAX ONLY)
In CANADA, please contact your local Panasonic dealer for more information on
Accessories.
Description
Credit Card #
Expiration Date
Customer Signature
Last
State
TO OBTAIN ANY OF OUR ACCESSORIES YOU CAN DO ANY OF
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
MAIL THIS ORDER TO: PANASONIC NATIONAL PARTS CENTER
20421 84th Avenue South, Kent, WA 98032
(For USA Customers)
Price Each Quantity
Shipping & Handling
Your State & Local Sales Tax
Phone#:
Day
Night
Zip
OR
OR
Total Price
$6.95
Subtotal
Total
( )
( )
(ENG) SQT0885
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