Model withdrawal form
Model withdrawal form

(If you want to cancel the contract, please fill out this form and send it back.)
-An Antje Silbermann, Puricellistraße 22, 93049 Regensburg, Fax:, Email: antje-silbermann@gmx.net

-Hereby give notice that ( ) I / we ( ) from my / our completed contract for the purchase of the following products ( ) / provision of the following services ( )

-Appointed on ( ) / received on ( )

Name of the / consumer ( )

-Address of person / consumer ( )

Signature of the / consumer ( ) (only with message on paper)
date

( ) Delete where inapplicable