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

To
I. O. R. Handels GmbH
Innungstr. 1a
50354 Hürth
info@ior-handels-gmbh.de

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),
_______________________________________________
_______________________________________________

Ordered on ___________________ (*)/received on _______________________(*)

Name of consumer(s) ______________________________________
Address of consumer(s)
_________________________________
_________________________________
_________________________________

Date:________________

Signature of consumer(s):___________________________________________
 (only if this form is notified on paper)

(*) Delete as appropriate