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(ENG) SQT0612 43
Digital Camera Accessory Order Form
Please photocopy this form when placing an order.
1. Digital Camera Model #
2. Items Ordered
Accessory # Description Price Each Quantity Total Price
Shipping & Handling $6.95
Subtotal
Your State & Local Sales Tax
Total
3. Method of payment (check one)
American Express
VISA Credit Card #
MasterCard Expiration Date
Discover Customer Signature
(Please do 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 DIGITAL CAMERA ACCESSORIES YOU CAN DO ANY OF
THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
YOU MAY CONTACT US DIRECTLY AT:
1-800-237-9080 (FAX ONLY)
OR
MAIL THIS ORDER TO: PANASONIC NATIONAL PARTS CENTER
20421 84th Avenue South, Kent, WA 98032