Model withdrawal form

 

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

To
neuefunktion.de
c/o Sybille Kesslau
Kolberger Str. 14
13357 Berlin
Germany
E-mail: info@neuefunktion.de


Hereby revoke I / we (*) from my / us (*) concluded contract for the purchase of the following products (*) / provision of the following services (*)

_______________________________________________
 

_______________________________________________


Appointed on ___________________ (*) / received on _______________________ (*)


Name of person / consumer (s) ______________________________________

Address of person / consumer (s)
 

_________________________________
 

_________________________________
 

_________________________________

 

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Date Signature of / consumer (s) (only with message on paper)

(*) delete where not applicable