withdrawal form

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