Withdrawal Sample Form

Sample Revocation Form

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


to
Pittgens Motorsport
Inh. Wilhelm Pittgens
Gartenstrasse 17
46519 Alpen
Germany

Fax: +49 (0) 2802-8072953
E-Mail: info@pittmo.com




Hereby, I / we (*) revoke the signed contract for the purchase of the following products (*) / provision of the following services (*)

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Order date ___________________ (*)/Received on _______________________(*)


Name of consumer(s)

_____________________________________


Address of consumer(s)


_____________________________________


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_________ _____________________________________________________
Date Signatur of consumer(s) (only with message on paper)

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(*) Delete where inapplicabel

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