withdrawal form

 
 
(If you want to cancel the contract, please fill out this form and send 
it back.) 
 
to 
Bernd Rosenzweig 
SmartPart Germany 
Meeraner Road 13b 
12681 Berlin 
 
Fax :030-60929466 
E-mail: smartpartsgermanygmx.de
 
 
Hereby give notice that (s) I / we (*) from my / us (*) concluded contract for the purchase of 
following products (*) / provision of the following services (*)
 
_______________________________________________ 
 
_______________________________________________
 
 
Appointed on ___________________ (*) / received on _______________________ (*) 
 
 
Name of person / consumer (s) ______________________________________ 
 
Address of person / consumer (s)
 
_________________________________ 
 
_________________________________
 
_________________________________ 
 
 
_______            _______________________________________________________ 
 
Date                  Signature of / consumer (s) (only with message on paper) 

 

 
(*) Delete where inapplicable

withdrawal form