Withdrawal form

(If you want to cancel the contract, please fill out this form and send it back.)

To:

Paolo Di Mitrio
Auf den Eichen 1
D-51674 Wiehl
Telefax: +49 2262 7616263
info@pdmcarparts.eu

I hereby revoke the contract I have concluded for the purchase of the following goods
 
_______________________________________________
_______________________________________________
 
Ordered on ___________________ received on _______________________
 
Customer name______________________________________
Customers adress
_________________________________
_________________________________
_________________________________
 
Date:________________
 
Signature of the customer:___________________________________________

(only for communication on paper)