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Camcorder Accessory Order Form (For USA Customers)

Please photocopy this form when placing an order.

  • 1.

    Palmcorder 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 MasterCard Discover

Credit Card # Expiration Date 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.

First

Last

Phone#: Day (

)

Street Address

Night (

)

City State Zip

TO OBTAIN ANY OF OUR PALMCORDER 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. 52

LSQT1284

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