Withdrawal

Complete and return this form only if you wish to withdraw from the contract.

To

Micro-Chiptuning Deutschland
Denis Jany
Am Mühlberg 6
06188 Landsberg / OT Hohenthurm
Germany

Fax: 034602-403174
E-Mail: info@micro-chiptuning.com

Withdrawal
Note: Delete as appropriate.
Name of consumer(s)
   
Address of consumer(s)
Your e-mail address, to immediately confirm the receipt of the withdrawal
Withdrawal date
Privacy I have read the privacy notice.
 

* required