Cancellation form
mySisas
Dirk Puley
Worderberg 1
42111 Wuppertal
Germany
E-Mail: info@mysisas.de
WITHDRAWAL FORM
(If you want to cancel the contract, please fill out this form and send it back to us.)
I / we (*) hereby revoke the contract concluded by me / us (*) for the purchase of the following goods (*) / the provision of the following services (*):
Ordered on (*) / received on (*)
Name of the consumer (s)
Street, House number, Addition
Postcode, City, PO box
Signature of the consumer (s) (only when notified on paper)
X
Date
(*) Please delete inapplicable.
