Model withdrawal form

MODEL WITHDRAWAL FORM

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

To

Silke Kadynski

Kiebitzweg 6

73230 Kirchheim unter Teck

info@teck-corals.de

I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract of sale of the following

goods (*)/for the provision of the following service(*),

________________________________________________

________________________________________________

Ordered on ___________________ (*)/received on _______________________

(*)Name of consumer(s) ______________________________________

Address of consumer(s)

____________________________________

____________________________________

____________________________________

Date:________________

Signature of consumer(s):___________________________________________

(only if this form is notified on paper)

(*) Delete as appropriate