MODEL WITHDRAWAL FORM

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

To
Lily / Marc Lu
Leipferdingerstr. 21
78250
shop@psy25.com

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