Sample cancellation form

Sample cancellation form

 
(If you want to cancel the contract, please fill out this form and send it back.)
    An
DXRacer Germany GmbH
Maßbrucher Weg 25
32657 Lemgo
Fax: 05261-6677618
E-Mail: info@dxracer-germany.de
I/we1 hereby revoke the contract concluded by me/us1 for the purchase of the following goods:
_________________________________________________________
_________________________________________________________
Ordered on: _____________________________________________
Received at: _____________________________________________
Name:            
_____________________________________________
Address:       
_____________________________________________
_____________________________________________
Signature:2 _____________________________________________
Datum:            _____________________________________________
 
 
 
1 Delete what is not applicable. 2 Only for notifications on paper.