(If you wish to withdraw the contract, please complete and return this form).
To
Patricia Reiners, Greifenhagenerstr. 39, 10437 Berlin, E-mail-address: hello@patriciareiners.de
I/we (*) hereby revoke the contract concluded by me/us (*) concerning the
purchase of the following goods (*)/provision of the following service (*)
______________________________________________________
______________________________________________________
Ordered on (*) ____________ / received on (*) _________________
_______________________________________________________
Name of the consumer(s)
_______________________________________________________
Address of consumer(s)
_______________________________________________________
Signature of the consumer(s) (only in case of paper communication)
_________________________
Date
(*) Delete where inapplicable.

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