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

 To _____________________________________________________________
[here is the name, the address and if applicable the fax number and e-mail address of the entrepreneur to be inserted by the entrepreneur]

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


_______________________________________________________________

Ordered on (*)/received on (*)


_______________________________________________________________
Name of the consumer(s)

_______________________________________________________________

 Address of the consumer(s)


Signature of the consumer(s) (only in case of communication on paper)

(*) Delete as applicable