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