Please | photocopy | this form | when | placing | an order. |
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1, Palmcorder | Model | # |
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2, Items | Ordered |
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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 | 6.95 |
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| Total | Enclosed |
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3. Method of payment (check one) |
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| Check of Money Order enclosed (NO C.O.D.SHIPMENTS) |
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C_] | VISA | Credit Card # |
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| MastefCard | 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)
4. Shipping information (UPS delivery requires complete street address
Ship To:
Mr.
Mrs.
Ms.
First | Lasl | Phone | #: |
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| Day | ( |
Street | Address |
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| Night | ( |
City | State | Zip |
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TO OBTAIN ANY OF OUR PALMCORDER ACCESSORIES YOU CAN DO ANY OF THE
FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
CALL PANASONIC'S ACCESSORY QRDER LINE AT
16
OR
MAiL THIS ORDER TO: PANASONIC SERVICES COMPANY ACCESSORY ORDER OFFICE
20421 84th Avenue South Kent, WA, 98032