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Withdrawal
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adenauer-electronic-systeme
Inhaber: Steinheuer Fred
Sillerystraße 5
D 53518 Adenau
Deutschland
Telefon: 02691 / 5989835
IBAN: DE66 5776 1591 1600 6706 01
BIC: GENODED1BNA
steinh.adenau@gmail.com
I/We hereby give notice that I/We withdraw my/our contract of sale of following goods/for the supply of the following service:
(name of the product, if applicable order number and price)
Ordered on:
Received on:
name and address of the consumer(s):
Name of consumer(s):
Address of consumer(s):
_____________________________________________________
date and signature of the consumer(s) (only if this form is notified on paper)
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