Sample Right of Withdrawal Form
Sample Withdrawal Form
(If you wish to withdraw from the contract, please complete this form and send it back.)
To
HEIKU Martin Kubiniok e.K.
Lohrheidestr. 58
44866 Bochum
Hereby I/we (*) withdraw from 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 consumer(s)
Address of consumer(s)
Signature of consumer(s) (only if this form is notified on paper)
Date __________
