Sample cancellation form
(If you wish to cancel the contract, please complete and return this form).
To
Dr. Galva GmbH
Jungholzstrasse 7a
76726 Germersheim
Germany
I/we (*) hereby revoke 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)
Signature of consumer(s) (only in case of paper communication)
Date
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(*) Delete where inapplicable.