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Please photocopy this form when placing an order.
1, Palmcorder Model #
2, Items Ordered
Accessory # Description Price Each Quantity Total Price
i
Subtotal
Your State & Local Sales Tax
Shipping & Handling 6.95
Total Enclosed
3. Method of payment (check one)
Check of Money Order enclosed (NO C.O.D.SHIPMENTS)
C_] VISA Credit Card #
MastefCard 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 Lasl
Street Address
Phone #:
Day (
Night (
City State Zip
TO OBTAIN ANY OF OUR PALMCORDER ACCESSORIES YOU CAN DO ANY OF THE
FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
CALL PANASONIC'S ACCESSORY QRDER LINE AT 1-800-332-5368
16AM-5 PM M_F,6 AM-10:30 AM SAT, PACIFIC TIME]
OR
MAiL THIS ORDER TO: PANASONIC SERVICES COMPANY ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA, 98032