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Digital Camera Accessory Order Form (For USA Customers)

Please photocopy this form when placing an order.

1.Digital Camera 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 DIGITAL CAMERA 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

(ENG) SQT0196 89

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Panasonic DMCFZ1000 owner manual Digital Camera Accessory Order Form For USA Customers