Withdrawal from contract form
by fax to: (0 52 42) 57 73 16
or by e-mail to: firstname.lastname@example.org
Herewith I/we* withdraw from my/our* legal contract regarding the purchase of the following goods* / the provision of the following services*
Ordered on*/ received on*
Customer(s) signature(s)(only applicable if submitted on paper)
* delete if not applicable..