Withdrawal Form


Complete and return this form only if you wish to withdraw from the contract


- To
Desiree Kosel und Khanh Pham GbR
Emminghaus str.47A
61250 Usingen
Germany


- 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),


- Signature of consumer(s) (only if this form is notified on paper),


- Date


___________
(*) Delete as appropriate.