withdrawal form 


If you want to revoke the contract, please fill out this form and send it back.  
At 
Pascale Wilde

Gallows Field 57

61389 Schmitten

pascale.wilde@gmail.com


I/we hereby revoke the contract concluded by me/us for the purchase of the following goods/the provision of the following service:  
.................................................. ............................ 
.................................................. ............................  (Name of the goods, order number and price if applicable)  
Goods ordered on:  
............................. Date 
Goods were recieved on: 
.......................  date  
Name and address of the consumer 
.......................  
.......................  
.......................  
.......................  date    
  .................................................. ..  Customer signature