Resi (modulo)

Withdrawal form

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

A:

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

I reject the contract I have concluded for the purchase of the following spare parts
 
_______________________________________________
_______________________________________________
Ordinato presso ___________________ ricevuto il _______________________
 
Nome del cliente _______________________________________
Indirizzo del cliente
_________________________________
_________________________________
_________________________________
 
Data:______________
 
Firma del cliente:_________________________________

(solo per la comunicazione su carta)