Sample - Withdrawal Form

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Sample - Withdrawal Form


If you wish to withdraw from this Contract, please fill in this form and send it back to:

René Reichel, trading under the business name of Bizarre-Lifestyle,
Mühlenberg 18
D-24857 Fahrdorf, Germany 
Fax: +49(0)4621-3024959, E-Mail:


 I / we (*) hereby withdraw from the contract I / we (*) concluded for the purchase of the following products (*) / provision of the following services (*):



ordered / procured on (*):

Received on (*):


Name of the consumer(s):


Address of the consumer(s):



Signature of the consumer(s) (only for communications on paper):



(*) Delete as appropriate