Please photocopy this form when placing an order.
Optional accessories
1. Model #
2. Items Ordered
Accessory # Description Price Each Quantity Total Price
3.Methodof payment (check one)
[]
[]
[]
[]
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 Payable to: PANASONIC ACCESSORIES
(Please do not send cash)
4. Shipping information (UPS delivery requires complete street address
Ship To:
Mr.
Mrs.
Ms.
First Last
Street Address
City State Zip
Phone#:
Day (
Night (
TO OBTAIN ANY OF OUR ACCESSORIES YOU CAN DO ANY OF
THE FOLLOWING:
VlSITYOUR LOCAL PANASONIC DEALER
OR
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-8368
[6AM-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
In CANADA, please contact your local Panasonic dealer for more information on Accessories.
O
169
LSQT1011
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