Sample withdrawal form

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

- An DESSENDO GmbH, Dormagener Str. 29, 50129 Bergheim, fax number: 0049.22714670499, e-mail address: widerruf@dessendo.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 the consumer(s)
- Address of the consumer(s)
- Signature of the consumer(s) (only in case of communication on paper)
- Date

(*) Inaccurate deletion.