Model withdrawal form

(complete and return this form only if you wish to withdraw from the contract)

- To
MATHO-Powertrain

Thomas Marx

Rieslingweg 12

D-74369 Loechgau

Germany
Email: marx.loechgau@gmx.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 (*),

- Number and date of invoice

- 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