Withdrawal

Complete and return this form only if you wish to withdraw from the contract.

To

Testfirma GmbH
Max Mustermann
Testweg 1
12345 Teststadt
Germany

Fax: 01212121212
E-Mail: admin@shop.de

Withdrawal
Note: Delete as appropriate.
Name of consumer(s)
 
Address of consumer(s)
Your e-mail address, to immediately confirm the receipt of the withdrawal
Withdrawal date
Privacy I have read the privacy notice.
 

* required