Cancellation form

(If you wish to revoke the contract, please fill up this form and send it back to us.) - To Robert Schmidt, Oberlausitzer Str. 42A, 02733 Cunewalde, Email address: : - I/we (*) herewith revoke the contract concluded by me/ us (*) regarding the purchase of the following products (*)/ the provision of the following service (*) - Ordered on (*)/ received on (*) - Name of the consumer(s) - Address of the consumer(s) - Signature of the consumer(s) (only in case of a notification on paper) - Date (*) Cross out the incorrect option.