Model Withdrawal Form

(If you want to withdrawl the contract, please fill out this form and send it back)
 
To
Erler-Zimmer GmbH & Co. KG
Hauptstr. 27
77886 Lauf
Germany
Phone: +49 (0) 7841 6003-0
Fax: +49 (0) 7841 6003-20
info@erler-zimmer.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