Panasonic PV-DV101 manual Please, Subtotal, Visa

Please	photocopy		this form	when	placing	an order.
1, Palmcorder		Model	#
2, Items	Ordered
Accessory		#	Description	Price	Each	Quantity	Total Price

i

				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)
C_]	VISA	Credit Card #
	MastefCard	Expiration	Date
[_}	Discover	Customer	Signature _

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	Lasl	Phone	#:
		Day	(
Street	Address
		Night	(
City	State	Zip

TO OBTAIN ANY OF OUR PALMCORDER ACCESSORIES YOU CAN DO ANY OF THE

FOLLOWING:

VISIT YOUR LOCAL PANASONIC DEALER

OR

CALL PANASONIC'S ACCESSORY QRDER LINE AT 1-800-332-5368

16 AM-5PM 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