model withdrawal form - Wellness

MODEL WITHDRAWAL FORM
If you want to withdraw the contract, please complete the form and send it back to:
Andre Götz, Inhaber und Anbieter von:
Wellness-Drinks
Eleonore-Sterling-Str. 20
60433 Frankfurt am Main
Telefax: 069 / 65303732
[email protected]
Withdrawal
- 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)
Date ___________________________
_____
(*) Delete as appropriate.

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