(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