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Withdrawal

To
MV-Kollektion Mike Voland
Marktplatz 11
97488 Stadtlauringen
Deutschland

Tel.: +49 (0)9724 90 77 977
Fax: +49 (0)9724 90 77 978
E-Mail: mv-kollektion@mike-voland.de
shop@mv-kollektion.de

I/We hereby give notice that I/We withdraw my/our contract of sale of following goods/for the supply of the following service:

(name of the product, if applicable order number and price)

Ordered on:
Received on:

name and address of the consumer(s):

Name of consumer(s):

Address of consumer(s):

_____________________________________________________
date and signature of the consumer(s) (only if this form is notified on paper)

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