
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  | 
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  | Subtotal  | 
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  | Your State & Local Sales Tax  | 
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  | Shipping & Handling  | 
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  | 6.95  | 
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3. Method of payment (check one)  | 
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  | Total Enclosed  | 
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  | Check of Money Order enclosed (NO C.O.D.SHIPMENTS)  | 
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  | VISA | Credit Card #  | 
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  | MasterCard  | Expiration Date  | 
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Discover  | Customer Signature  | 
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  | Make Check or Money Order to: PANASONIC ACCESSORIES  | ||||||||||||
(Please do not send cash)  | 
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4. Shipping information (UPS delivery requires complete street address)  | ||||||||||||||
Ship To:  | 
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Mr.  | 
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Mrs.  | 
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Ms.  | 
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  | Phone#:  | 
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  | First  | Last  | 
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  | Street Address  | 
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  | Night  | 
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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 
[6 
OR
MAIL THIS ORDER TO: PANASONIC SERVICE AND TECHNOLOGY COMPANY
ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA. 98032
(ENG) VQT2M30 39