Withdrawal form

(If you want to cancel the contract, please fill out this form and send it back.)

I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*)

- Ordered on (*)/received on (*)

- Name of the consumer(s)

- Address of the consumer(s)

- Signature of the consumer(s) (only for paper notification)

- Date

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(*) Delete what is not applicable.