withdrawal form

(complete and return this form only if you wish to withdraw from the contract)
To: HML Fetish, Inhaber Detlef Moller
street and housenumber Neukirchstr. 18
land/city DE-28215 Bremen
Tel.: +49 421 371430
Fax: +49 421 374953
e-Mail: info@hm-leder.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: einzug
received on: einzug

sender of withdrawal:  
Name of consumer(s): einzug
Address of consumer(street + number): einzug
Address of consumer(ZIP, city and land): einzug

einzug einzug
Date Signature of consumer(s) (only if this form is notified on paper)
(*) Delete as appropriate.