Accessory Order Form (For USA 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

3. Method of payment (check one)

 

 

 

 

 

 

Total Enclosed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

150

VQT1T93

Page 150
Image 150
Panasonic HDC-HS100PC operating instructions Accessory Order Form For USA Customers, 150, Visa