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B. Cancellation Form
If you would like to withdraw from the contract, please fill out this form and send it to:
Japan - Carparts
Maasambacht 11
2676AW Maasdijk
Netherlands
E-mail: [email protected]
Tel: +31 174 512 530
I/We (*) hereby give notice that I/we (*) withdraw from the contract of sale of the following goods/provision of the following service (*)
___________________________________________________________________
___________________________________________________________________
Ordered on (*) ____________________ / Received on (*) ____________________
___________________________________________________________________
Name of Consumer(s)
___________________________________________________________________
Address of Consumer(s)
___________________________________________________________________
Signature of Consumer(s) (only for paper notice)
___________________________________
Date
(*) Delete as applicable
Japan - Carparts
Maasambacht 11 | Tel: | +31 (0)174 - 512 530 |
2676 AW Maasdijk | Fax: | +31 (0)174 - 512 530 |
Netherlands | ||
VAT: | NL809706787B01 | |
Chamber of Commerce: | 27196623 |