Main page » Model withdrawal form

Withdrawal

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

To

LöSi Getriebe-Steuerungen-Hydraulik GmbH
Andreas Klöss
Merkurstraße 52 Merkurstraße 52
67663 Kaiserslautern
Germany

Fax: +496313512444
E-Mail: info@hydraulikshop-loesi.de

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Withdrawal

Order no.

Withdrawal

Note: Delete as appropriate.

Ordered on

Received on

Name of consumer(s)

Salutation

Mr Miss/Ms/Mrs None

Firstname

Lastname

Address of consumer(s)

No./Street

Postcode / Town

Country

Your e-mail address, to immediately confirm the receipt of the withdrawal

Your e-mail

Withdrawal date

Privacy I have read the privacy notice.

* required