Withdrawal form

(fill out this form and send it back only if you wish to withdraw from the contract. The form should be printed, signed, and sent as a scanned copy to the email address below, or included in the return shipment of the goods).

Recipient

Online store: Mototechnik

Company: Vojtěch Hlásný

Address: Býšť 136, 53322 Býšť

VAT ID: 74854551

Email address: info@mototechnik.cz

Phone number: 724205024

I hereby inform that I am withdrawing from the contract for the purchase of the following goods :

 

 

• Order date:
• Order number:
• The payment for the order, and possibly for delivery, was made using
  and will be refunded using (if transferred to an account, please provide the account number)

 

 

• Consumer's name:
• Consumer's address:
• Email:
• Phone:

 

In                                             , on

 

                                  (signature)
______________________________________

             Consumer's name