Sample withdrawal form

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

- To Andreas Stubenbord, Gschächtrig 2/1, 79348 Freiamt, email address:  fragrantair@stubenbord.de :

- I/ we (*) hereby revoke the contract concluded by me/ us (*) for the purchase of the following goods (*)/
  the provision of the following service (*)

- Ordered on (*)/ received on (*)

- Name of consumer(s)
- Address of the consumer(s)
- Signature of the consumer(s) (only if notification is made on paper)
- Date

(*) Delete where not applicable.