If you want to cancel the contract, please fill out this form and send it back.

To
 

I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*)

 _______________________________________________
 _______________________________________________
 

Ordered on _______________________ (*)/received on _______________________(*)

Name of the consumer(s) ___________________________________________________
 

Address of the consumer(s)
 _________________________________
 _________________________________
 _________________________________
 

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Date Signature of the consumer(s) (only for paper notification)

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(*) Delete as appropriate