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Model Withdrawal Form

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

To:

Asia-Tec Motorradzubehör

Jochen Lehnert

Adelholzener Str. 20a

D- 83313 Siegsdorf

Fax: 08662/663819

Mail: Anfrage@Asia-Tec.com

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),

..........................................................................................................

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 .................................................................................................

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(*) Delete as appropriate.