Panasonic HM-TA1, VQT2Z95-1 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

			Subtotal
	Your State & Local Sales Tax
		Shipping & Handling		6.95
			Total Enclosed
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 Payable to: PANASONIC ACCESSORIES

(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 SERVICE AND TECHNOLOGY COMPANY

ACCESSORY ORDER OFFICE

20421 84th Avenue South Kent, WA. 98032

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

72VQT2Z95