(If you want to withdraw from the contract, please fill out this form and send it back)
To
J.G. Lorey Sohn Nachfolger GmbH & Co KG
Schillerstr. 16
60313 Frankfurt am Main
Telefax: +49 (0) 69 29995-30
info@lorey.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
