withdrawal form

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

1.To

Ute Weidenthaler-Musiolik, Rainer Musiolik
Kettelerstr.19, 76768 Berg - Germany
Email: info@weidenthaler.shop



2. I / We (*) hereby revoke my / our (*) contract for the purchase of the following
good(s)(*) / the provision of the following service (*):

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________
(Name oft he good, possibly order number and price)




3. Ordered on / received at (*): ______________________________
(Date)



4. Name and address:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

5. Date ___________________________________

_____________________________________________________________________
Signature (only if the message is sent on paper)

................................................
(*) delete if not applicable.