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Please photocopy this form when placing an order.
1. Camcorder Model #
2. Items Ordered
Accessory# Description Price Each Quantity
Subtotal
Your State & Local Sales Tax
Shipping & Handling
Total Enclosed
Total Price
6.95
3. Method of payment (check one)
[] 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)
Ship To:
Mr.
Mrs
Ms.
First
Last Phone #:
Day ( )
Street Address
Night ( )
City State Zip
TO OBTAIN ANY OF OUR CAMCORDER ACCESSORIES YOU CAN DO ANY OF THE
FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-5368
[6 AM-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
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