Cancellation form
Model withdrawal form
(If you wish to withdraw from the contract, please fill in this form and send it back.)
• To Raik Dominus, Sielower Waldstr. 5, 03055 Cottbus, Germany
• 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)
• Signature of consumer(s) (only if this form is notified on paper)
• Date
(*) Delete as appropriate.
End of the model withdrawal form
