Model Withdrawal Form

(If you wish to withdraw from the contract, please complete this form and send it back to us.)

To:

Zentrum für Prävention und Ernährung
Owner: Ihor Bezuhliy
Joachim-Karnatz-Allee 47
10557 Berlin
Germany

E-mail: info@bezugla.de
Phone: +49 175 7495618

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

(Name of the service / goods)

Ordered on () / received on ()

Name of the consumer(s)

Address of the consumer(s)

Date

Signature of the consumer(s) (only if this form is submitted on paper)

(*) Delete as appropriate.