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Please photocopy this form when placing an order.
1. Digital Camera Model #
2. Items Ordered
Accessory # Description Price Each
3. Method of payment (check one)
Quantity Total Price
Subtotal
Your State & Local 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 do not send cash)
4. Shipping information (UPS delivery requires complete street address)
ShipTo:
Mr.
Mrs.
Ms.
First Last Phone#:
Day ( )
Night ( )
Street Address
City State Zip
TO OBTAIN ANY OF OUR DIGITAL CAMERA ACCESSORIES YOU CAN DO ANY OF
THE FOLLOWING:
VlSITYOUR LOCAL PANASONIC DEALER
OR
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-5368
[6 AM-6 PM M-F, PACIFIC TIME]
OR
MAIL THIS ORDER TO: PANASONIC SERVICE AND TECHNOLOGY COMPANY
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
In CANADA, please contact your local Dealer for more information about accessories.
VQT1M97111