Panasonic HX-A1M Basic Owners Manual - Page 37

Accessory Order Form - price

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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 Shipping & Handling Subtotal Your State & Local Sales Tax 3. Method of payment (check one) Total 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. First Street Address City Last State Zip Phone#: Day ( ) Night ( ) 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 $6.95 In CANADA, please contact your local Panasonic dealer for more information on Accessories. 37 (ENG) SQT0885

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37
(ENG) SQT0885
Accessory Order Form
(For USA Customers)
In CANADA, please contact your local Panasonic dealer for more information on
Accessories.
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
Ship To:
Mr.
Mrs.
Ms.
First
Last
Street Address
City
State
Zip
Phone#:
Day
(
)
Night
(
)
4. Shipping information (UPS delivery requires complete street address)
Please photocopy
this form when placing an order.
3. Method of payment (check one)
American Express
VISA
MasterCard
(Please do not send cash)
2. Items Ordered
Quantity
Accessory #
Price Each
Description
Total Price
$6.95
Subtotal
Your State & Local Sales Tax
Shipping & Handling
Total
1. Model #
Discover
Expiration Date
Credit Card #
Customer Signature