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Model Withdrawal Form

(If you wish to withdraw from the contract, please fill out this form and send it back.)

To Steffen Musial, Fuststr. 46, 12459 Berlin, email address: info@it42life.de

I/we () hereby withdraw from 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 consumer(s)

Address of consumer(s)

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

Date

(*) Delete as appropriate.