Revocation form

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

To:

Harzer Handels GmbH, Kornstr. 17, 06493 Ballenstedt Kontakt: mail (.at.) Hahage.de

Hereby I/we withdraw (*) by me/us (*) contract for the sale of the following goods (*) / the provision of the following services (*)

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Ordered the (*) / get most (*)

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Name of / the consumer (s)

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Address of / the consumer (s)

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Signature of / the consumer (s) (only for communication on paper)

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Date

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(*) Delete as appropriate.