withdrawal form

Model withdrawal form

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


Markus Klein,

Dahlemer Str. 30

33619 Bielefeld



I / we (*) hereby revoke that of me / us (*)  concluded contract for the purchase of the following goods (*)  / providing the following service (*)

- Ordered on (*                                            )

/received at (*                                            )

- name of the consumer (s)

- address of the consumer (s)


- Signature of the consumer (s) (only when notified on paper)


- date

(*) Delete as appropriate.