(If you want to withdraw from the contract, please fill out this form and send it back)
To
Auvidea GmbH
Egart 5
D-86920 Denklingen
Telefax: (_____)
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
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