Model withdrawal form

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

To

Whizz-Wheels, Jochen Reichert + Bernd Warth GbR

Hegnerweg 17

71101 Schönaich

Telefax: 07031 23 25 26

info@whizz-wheels.de

I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),

_______________________________________________

Ordered on ___________________ (*)/received on _______________________(*)

Name of consumer(s) ______________________________________

Address of consumer(s)

_________________________________

Date:________________

Signature of consumer(s):___________________________________________

(only if this form is notified on paper)

(*) Delete as appropriate