Appendix I: Model withdrawal for

Model withdrawal form

(only complete and return this form if you want to withdraw from the contract)

a. To: [name of entrepreneur]
[geographic address of the entrepreneur]
[entrepreneur's fax number, if available]
[entrepreneur's e-mail address or electronic address]

b. I / We * share / share * hereby that I / we * our agreement regarding
the sale of the following products: [designation product] *
the delivery of the following digital content: [digital content description] *
the provision of the following service: [designation of service] *,
revoked / revoked *

c. Ordered on * / received on * [order date with services or receipt with products]
d. [Consumer (s) name]
e. [Consumer (s) address]
f. [Consumer (s) signature] (only if this form is submitted on paper)

* Cross out what does not apply or fill in what applies.