MODEL WITHDRAWAL FORM

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

To

Scrapbook Werkstatt
Ulrike Dold
Holderäckerstr.12
70839 Gerlingen
shop@scrapbook-werkstatt.de

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 (*),

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Ordered on ___________________ (*)/received on _______________________(*)

Name of consumer(s) ______________________________________

Address of consumer(s)

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_________________________________

_________________________________

Date:________________

Signature of consumer(s):___________________________________________

(only if this form is notified on paper)

(*) Delete as appropriate