30
SQT1126 (ENG)
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
VISIT OUR WEBSITE AT:
http://shop.panasonic.com/
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
HC-V180PP-SQT1126_mst.book 30 ページ ２０１５年１０月３０日 金曜日 午後１時３１分
