Sample withdrawal form

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

- To FAHRER Berlin GmbH, Roelckestraße 92, 13088 Berlin, fax number: +49 30 69 20 59 29 9, e-mail address: shop@fahrer-berlin.de :

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

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

- Name(s) of consumer(s)
- Address of consumer(s)
- Unterschrift des/ der Verbraucher(s) (nur bei Mitteilung auf Papier)
- Date

(*) Delete as appropriate.