Panasonic HX-A500 - Accessory Order Form (for USA Customers)

36
SQT0251 (ENG)
Accessory Order Form (For USA Customers)
In CANADA, please contact your local Panasonic dealer for more information on
Accessories.
TO OBTAIN ANY OF OUR 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
Ship To:
Mr.
Mrs.
Ms.
First Last
Street Address
City State Zip
Phone#:
Day
( )
Night ( )
4. Shipping information (UPS delivery requires complete street address)
Please photocopy this form when placing an order.
3. Method of payment (check one)
American Express
VISA
MasterCard
(Please do not send cash)
2. Items Ordered
QuantityAccessory # Price Each Description
Total Price
$6.95
Subtotal
Your State & Local Sales Tax
Shipping & Handling
Total
1. Model #
Discover
Expiration Date
Credit Card #
Customer Signature
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