Withdrawal form

Model withdrawal form

(complete and return this form only if you wish to withdraw from the contract)

To:

Hercon GmbH

Auf dem Loor 39

51143 Köln

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 (*)

Ordered on (*)/received on (*)

Name of consumer(s)

Address of consumer(s)

Signature of consumer(s) (only if this form is notified on paper)

Date

___________

(*) Delete as appropriate.