I/we (*) hereby cancel the contract concluded by me/us (*) for the purchase of the following goods (*) (1)_____________________________ (2)_____________________________ (3)_____________________________ (4)_____________________________ (5)_____________________________ (continue as far as more articles have been purchased and their purchase contract is to be revoked)
Ordered on ____________________ (*)/received on ____________________ (*) ________________________(Your name) ________________________(Road, House number) ________________________(Postcode, Location) ______________(Date) ___________________________ Your signature (only if you are sending a paper copy) (*) Delete where inapplicable
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