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

To:
Automotive Konzepte OHG
Nürburgring Boulevard 2
53520 Nürburg


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)


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

Date

___________
(*) Delete as appropriate.