(complete and return this form only if you wish to withdraw from the contract)
— To Jutta Möller, Burggartenstrasse 19, 53115 Bonn, Germany; firstname.lastname@example.org
— 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)
(*) Delete as appropriate.