Model Withdrawal Form

Model Withdrawal Form

Model Withdrawal Form

 

 

 

 

 

 

 

 

 

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

 

To

ECONLUX GmbH

Industriestrasse 154

50996 Köln

info@econlux.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