SAMPLE CANCELLATION FORM

(If you want to cancel the contract, please fill out this form and send it back.)

To Juwelier Timeless, Bahnhofstrasse 15 71332 Waiblingen Tel.: 07151 51477 Timeless121@live.de

I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*) _______________________________________________ _______________________________________________ Ordered on ___________________ (*)/received on _______________________(*) Name of consumer(s) ______________________________________ Address of consumer(s) _________________________________ _________________________________ _________________________________ Date:________________ Signature of consumer(s):___________________________________________ (only if notification is on paper) (*) Delete as appropriate.