Sample Withdrawal Form

(If you want to withdraw from the contract, please fill out this form and return it.)

To
WLAN-Shop24.de
Diversitas Hamburg GmbH
Von-Bargen-Straße 18
22041 Hamburg
Fax: +49-40-20906700
Email: Info@WLAN-Shop24.de

I/we () hereby withdraw from the contract concluded by me/us () for the purchase of the following goods () / the 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 for communication on paper)

Date

(*) Delete as appropriate