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Model Withdrawal Form

 

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

To

Iphoria Design GmbH

Brunnenstraße 114

13355 Berlin

info@iphoria.com

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