Withdrawal

Complete and return this form only if you wish to withdraw from the contract.

To

Margit E. Dellee GmbH
Joachim Block
Kirschgarten 9
55116 Mainz
Germany

Fax: 0 61 31-23 87 82
E-Mail: info@potpourri-mainz.de

Withdrawal
Note: Delete as appropriate.
Name of consumer(s)
 
Address of consumer(s)
Your e-mail address, to immediately confirm the receipt of the withdrawal
Withdrawal date
Privacy I have read the privacy notice.
 

* required