(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: [email protected]
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.