MODELLO DI RECESSO  -  MODEL WITHDRAWAL FORM

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

To

Horns24 Inh. Marcus Leidiger

Barbarastr. 64

50735 Köln

Telefax: +49-221-1699815

info@horns24.de

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 paper)

(*) Delete as appropriate