Model Withdrawal Form – BAD PORTIER

(If you wish to withdraw from the contract, please complete this form and return it to us.)

To:
Internet Value GmbH
Marienstraße 14
40212 Düsseldorf
Germany
Email: info@badportier.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): ___________________________

Signature of consumer(s) (only if this form is submitted on paper): ___________________________

Date: ___________________________

(*) Delete as appropriate.