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

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

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

32

SQT0003 (ENG)

Page 32
Image 32
Panasonic HC-V250P/PC, HC-V550P/PC owner manual Accessory Order Form For USA and Puerto Rico Customers, Visa