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Model Withdrawal Form

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

 

To

Iphoria Design GmbH
Brunnenstraße 114
13355 Berlin
info@iphoria.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

 

Please send returns to:

Peter Jäckel
Kommunikationssysteme GmbH 
          
Borsigstr. 5
D- 31061 Alfeld/Leine