Withdrawal Form

MODEL WITHDRAWAL FORM

 

(If you want to withdraw from the contract, please fill out this form and send it back to us, for example by email. You can also use the "Withdraw from contract" button on our website.)

 

To:

Sylvia Rohland – Glanceivory

Luckenwalder Str. 30

12629 Berlin

Germany

Email: support@glanceivory.com

 

I/We (*) hereby withdraw from the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*):

 

Product(s): ______________________________________

 

Order number: ____________________________________

 

Ordered on (*) / received on (*): ______________________

 

Name of consumer(s): _____________________________

 

Address of consumer(s): __________________________

 

__________________________________________________

 

Signature of consumer(s) (only if this form is sent on paper): ____________________

 

Date: ____________________

 

(*) Delete as appropriate.