Withdrawal

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

To

Funk - TV - Petzold
Hans Petzold
Göltzschstraße 24
08228 Rodewisch
Germany

Fax: 03744/35314
E-Mail: info@funktvpetzold.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