![](/images/new-backgrounds/1179382/179382275x1.webp)
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 | |||||
|
|
|
|
|
|
|
|
|
|
|
|
| Total Enclosed |
| |||
|
|
|
|
|
|
|
|
|
|
|
|
|
| ||||
3. Method of payment (check one) |
|
|
|
|
|
|
|
|
|
|
| ||||||
|
|
|
|
|
|
|
|
|
|
| |||||||
| 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
[6
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.