Sample Withdrawal Form
(If you want to withdraw from the contract, please fill out this form and return it.)
To
WLAN-Shop24.de
Diversitas Hamburg GmbH
Von-Bargen-Straße 34
22041 Hamburg
Fax: +49-40-20906700
Email: Info@WLAN-Shop24.de
I/we () hereby 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 the consumer(s)
Address of the consumer(s)
Signature of the consumer(s) (only for communication on paper)
Date
(*) Delete as appropriate