Model withdrawel form

(If you want to withdrawl the contract, please fill out this form and send it back.)

To

Pirate, Ronald Prinzlau e.K

Dockenhudener Ch.119

25469 Halstenbek

info@pirate.biz

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 pape)



(*) Delete as appropriate