Withdrawal form

(In order to exercise your right of withdrawal, please enter the relevant data in the following form and send it to us.)

I hereby revoke the contract I have concluded for the purchase of the following goods:

Ordered goods

Order date:

Reference date:

First name:

Last name:

Street

No:

ZIP

Location

E-Mail

Today's date

Datenschutz

Yes, I have read the privacy policy and agree that the data I have provided will be collected and stored electronically.