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Sample withdrawal form

(If you want to revoke the contract, please fill out this form and send it back.)



Atelier Claudia Delissen

Vorster Street 514

41169 Moenchengladbach





I/we hereby revoke (*)

the contract concluded by me/us (*) for the purchase of the following goods(*)

Ordered on (*)/received on (*)

Name of the consumer(s): Address of the consumer(s): (only with revocation 

Signature of consumer(s) 


(*) Delete where not applicable.

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