Categories 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
