MODEL WITHDRAWAL FORM

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

To:
rezer sp. z o.o.
ul. Adolfa Mitery 11
32-700 Bochnia, Poland
contact@rider-tyres.eu

I/We(*) hereby give notice that I/we(*) withdraw from my/our(*) contract of sale of the following goods:

................................................................................

Ordered on / received on(*): .....................................................

Name of consumer(s): ............................................................

Address of consumer(s): .........................................................

Order number (optional): ........................................................

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

................................................................................

Date: ...........................................................................

(*) Delete as appropriate.