Panasonic, Ship-to address, From – Panasonic KX-TD500 User Manual

Page 16: Purchased from, Method of payment, Method of shipment

Panasonic

KX-TD500 CPU & SPARES KIT

ORDER FORM

TO: NPC ORDER DESK (1-800-237-9080)

ATTN: Wanda Connors

I M P O R T A N T

You must purchase a KX-TD500 spares kit with the purchase of your first CPU. One spares kit purchase
permitted per dealer. Only one CPU purchase permitted with the purchase of each KX-TD500 Basic Shelf.

Instructions to order a KX-TD500 CPU or Spares Kit:
1. Complete all information on this form. Items 1 through 5
2. Attach a copy of the invoice you received from your Panasonic distributor that clearly shows your dealership’s
name and address, distributor name and address, the Basic Shelf, model number (KX-TD500), quantity, and
date of purchase.
3. Shipping cost not included in CPU or SPARES KIT costs.
4. Fax to 1-800-237-9080

1. FROM

YOUR DEALERSHIP NAME:________________________________________________________________

STREET:___________________________________________________________________________________________

CITY:_______________________________________________________STATE:_________ZIP CODE:_______________

RETURN FAX #: __________________PHONE #:_____________________DATE: ________________________________

DEALERSHIP ID (9 Digits): _____________________________CONTACT NAME:________________________________

2. SHIP-TO ADDRESS

NAME: ____________________________________________________________

STREET ADDRESS:

CITY:

STATE:

ZIP CODE:

3. PURCHASED FROM

DISTRIBUTORS NAME: ___________________________________________________

STREET: ____________________________CITY: _____________________________STATE: ________ZIP:_________

KX-TD500 SERIAL NUMBER: ____________________________ DATE OF PURCHASE: _______________

4. METHOD OF PAYMENT

PASC ACCOUNT VISA MASTER AMEX DISCOVER

PASC ACCOUNT OR CREDIT CARD NUMBER: ___________________________________________EXPIRATION DATE __/__

5. METHOD OF SHIPMENT

UPS Ground UPS Blue UPS Red Other______________

Part Number

Price

QTY

PO #

KX-TD50101-1 CPU Card
UG-KX-TD500 User Guide

$700.00

SPARES KIT

$1795

CUSTOMER CONTROL #:

(TO BE FILLED IN BY NPC STAFF)

NPC USE:

Keyed By:

Faxed Date:

030999