Withdrawal form

Please fill in this form if you want to withdraw from the contract and send it to:

 

GEDAT Datentechnik GmbH
Antonstra├če 3
D-09337 Hohenstein-Ernstthal

Phone +49 3723 / 66 78 -0
Fax +49 3723 / 66 78 79
E-Mail: vertrieb@gedat.com


I hereby give notice that I withdraw from my contract of sale of the following goods.

Goods:

              Quantity   x   Product                            Article-Number
x   
x   
x   

Total Price
Euro

Date of order

Goods received on

Personal data

First name / Family name

Streetname / Nr.

Zip

Town


E-Mail


Date