Panasonic HX-A100K, HXA100D, HXA100K Accessory Order Form For USA and Puerto Rico Customers, Visa

Accessory Order Form (For USA and Puerto Rico Customers)

Please photocopy this form when placing an order.

1. Model #

2. Items Ordered

Accessory #		Description		Price Each			Quantity				Total Price
						Shipping & Handling					$6.95
								Subtotal
					Your State & Local Sales Tax
									Total
3. Method of payment (check one)
	American Express
	VISA	Credit Card #
	MasterCard	Expiration Date
Discover		Customer Signature
(Please do not send cash)
4. Shipping information (UPS delivery requires complete street address)
Ship To:
Mr.
Mrs.
Ms.							Phone#:
	First	Last
							Day	(		)
	Street Address
							Night	(		)
	City		State		Zip

TO OBTAIN ANY OF OUR 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 NATIONAL PARTS CENTER

20421 84th Ave. S., Kent, WA 98032

In CANADA, please contact your local Panasonic dealer for more information on Accessories.

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