Withdrawal form

Please fill out all of the entry fields labelled with *.

To: om bastic AG, mossitive, Gungstr.3, 46240 Bottrop, Deutschland, Tel. +49 2041 3785844, Fax +49 2041 3785855, info@moosartig.de
I/We* hereby give notice that I/We* withdraw from my/our* contract of sale of the following goods:
Listing of goods: *
Ordered on: *
Received on: *
Your name: *
Postcode, City *
Street Nr. *
Date of withdrawal *
Your email address *
emailaddress *
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