sample cancellation form

Sample cancellation form

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

- An: loeweli Inh. Anett Löwe, Rückertstr. 4 04157 Leipzig

- I/we (*) hereby revoke the purchase contract concluded by me/us (*). of the following goods (*)

- Invoice number (or order number)

- Ordered on (*)/received on (*)

- Name of the consumer(s)

- Address of the consumer(s)

- Signature of the consumer(s) (only for notification on paper) - Date