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

To

Einzelunternehmen (Gewerbetreibender): Robert Weber

Gerhart-Hauptmann-Str. 78

90763 Fürth

info@slotcarusa.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