MODEL WITHDRAWAL FORM

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

Boneka Tradition Claudia Hillesheim

Falkenecksweg 39

35619 Braunfels

claudia.hillesheim@web.de

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)

_________________________________




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

(*) Delete as appropriate