Model withdrawal form
(Complete and return this form only if you wish to withdraw from the contract.)

To AEZ Autoelektrik Zentrum, Abdullatif Namal,
Werkstraße 4, 46240 Bottrop, Germany, email: info@aez-pro.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): _________________________________

________________________________________________________

Signature of consumer(s) (only if this form is notified on paper):

________________________________________________________

Date: __________________________________________________

(*) Delete as appropriate.