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Sample withdrawal form
(If you want to revoke the contract, please fill out this form and send it back.)
At:
Atelier Claudia Delissen
Vorster Street 514
41169 Moenchengladbach
mail: info@claudia-delissen.de
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)
Date
(*) Delete where not applicable.
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