Cancellation form
Model withdrawal form
If you want to cancel the contract, please fill in this form
and send it back.
On
Puranova GmbH
Hohenzollernring 16
D - 50672 Cologne
I / we hereby revoke the contract concluded by myself / us
the purchase of the following goods / the provision of the following services:
.................................................. ............................
.................................................. ............................
(Name of the goods, order number and price, if applicable)
Goods ordered on:
.............................
date
Goods were recieved on:
.............................
date
Name and address of the consumer
.............................
.............................
.............................
date
.................................................. ..
Customer signature
(only with written revocation)
