Sample - Withdrawal Form

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Sample - Withdrawal Form

If you wish to withdraw from this Contract, please fill in this form and send it back to:

Ren Reichel, trading under the business name of Bizarre-Lifestyle,
Mhlenberg 18
D-24857 Fahrdorf, Germany
Fax: +49(0)4621-3024959, E-Mail: shop@heavyrubber-shop.com

I / we (*) hereby withdraw from the contract I / we (*) concluded for the purchase of the following products (*) / provision of the following services (*):

ordered / procured on (*):

Received on (*):

Name of the consumer(s):

Address of the consumer(s):

Signature of the consumer(s) (only for communications on paper):

Date:

___________________________________
(*) Delete as appropriate