Model Withdrawal

 
 

 

(You can either print out the form displayed on this page or download it here)

Model withdrawal form

 

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

 

To

MIAMED GmbH

Sachsenring 73

50677 Köln

Germany

Fax: +49 30 5770221-99

E-Mail: info@amboss.com

- 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),

 

__________________________________________________________

 

- Signature of consumer(s) (only if this form is notified on paper),

 

__________________________________________________________

 

- Date

 

__________________________________________________________

(*) Delete as appropriate.