Sample cancellation form

(If you wish to cancel the contract, please complete and return this form).

TO:

VERTRIEB JÖRG KULLING

INH. JÖRG KULLING

BOXHAGENERSTR. 106

10245 BERLIN

DEUTSCHLAND

INFO@CORONATION-INDUSTRIES.DE

FAX 030-44024214

- I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*)/provision of the following service (*)

- Ordered on (*)............................................/received on (*)............................................

- Name of the consumer(s) ...................................................................................

- Address of the consumer(s) ..............................................................................

…..................................................................................................................................

- Signature of the consumer(s) (only in the case of a paper notification) .....................................................................................

- Date ...........................................................................

(*) Delete if necessary.