Panasonic Lumix DMC-FS4

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
Subtotal
Your State & Local Sales Tax
Shipping & Handling
6.95
Total Enclosed
3.
Method of payment (check one)
Expiration Date _
Customer Signature _
Discover
MasterCard
o Check of Money Order enclosed (NO C.OD.SHIPMENTS)
o VISA Credit Card # _
o
o
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
Street
Address
Last
Phone#:
Day -'-( _"---- _
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
CALL PANASONIC'S ACCESSORY ORDER LINE AT 1-800-332-5368
[6 AM-6 PM M-F, PACIFIC TIME]
OR
MAIL THIS ORDER TO: PANASONIC SERVICE AND TECHNOLOGY COMPANY
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
28 VQT2B45 (ENG)