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Withdrawal

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

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

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

Withdrawal

Order no.

Withdrawal (optional)

Note: Delete as appropriate.

Ordered on

Received on

(optional)

Name of consumer(s)

Salutation (optional)

Mr Miss/Ms/Mrs None

Firstname

Lastname

Your e-mail address, to immediately confirm the receipt of the withdrawal

Your e-mail

Address of consumer(s)

No./Street (optional)

Postcode / Town (optional)

Country (optional)

Privacy I have read the privacy notice.

* required

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