Cancellation form

Sample cancellation form:

If you wish to revoke the contract, please complete this form and return it to:

Viertec GmbH
Anholter Str. 60a
46459 Rees-Millingen

E-mail: online@viertec.de

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

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Ordered on (*) _____________ / received on (*) _________________

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Name of the consumer(s)

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Address of consumer(s)

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Signature of the consumer(s) (only in case of paper communication)

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Date

(*) Delete where inapplicable