Cancellation form
(If you want to cancel the contract, please fill out this form and send it back.)
An
DampfWatt Agentur UG (haftungsbeschränkt)
Brüggeweg 45
D-45768 Marl
[here the entrepreneur must insert the name, address and, if applicable, the fax number and email address of the entrepreneur]:
I/we (*) hereby revoke 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 the consumer(s)
_________________________________
_________________________________
_________________________________
_________ __________________________________________________________________________
Date Signature of the consumer(s) (only if notification is on paper)
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(*) Delete as appropriate