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Please photocopy this form when placing an order.

1. Digital Camera Model #
2. Items Ordered
Accessory # Description Price Each Quantity Total Price
Shipping & Handling $6.95

Subtotal
Your State & Local Sales Tax
Total
3. Method of payment (check one)
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 Last Phone#:
Day ( )
Street Address
Night ( )
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TO OBTAIN ANY OF OUR DIGITAL CAMERA ACCESSORIES YOU CAN DO ANY OF

THE FOLLOWING:
VISIT YOUR LOCAL PANASONIC DEALER
OR
VISIT OUR WEBSITE AT:
http://shop.panasonic.com/
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Panasonic Corporation of North America

Two Riverfront Plaza, Newark, NJ 07102-5490
http://shop.panasonic.com
Panasonic Canada Inc.

5770 Ambler Drive, Mississauga, Ontario L4W 2T3
www.panasonic.com
 Panasonic Corporation 2015
Printed in China

DMC-GX8 en Om

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Date of Purchase Dealer Phone No.

Dealer Address Serial No.

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Please photocopy this form when placing an order.

Shipping & Handling $6.95

4. Shipping information (UPS delivery requires complete street address)

TO OBTAIN ANY OF OUR DIGITAL CAMERA ACCESSORIES YOU CAN DO ANY OF

Panasonic Corporation of North America

Panasonic Canada Inc.

 Panasonic Corporation 2015

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