Model withdrawal form

SAMPLE CANCELLATION FORM

(IF YOU WOULD LIKE TO WITHDRAW FROM THE CONTRACT, PLEASE FILL IN THIS FORM AND RETURN IT TO US.)

To:

Feuerstein GmbH

Email: info@molotow.com
Tel. +497821922290
Fax: +4978219222999

I/we (*) hereby withdraw from the contract concluded with 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 where notice submitted in paper form)

Date

___________________________________

(*) Delete as appropriate

Issued by:

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