Withdrawal form

Model withdrawal form:

(Please complete and return this form only if you wish to withdraw from a order)

Peter Bausch GmbH & Co. KG
Blombachstr. 21-23
42369 Wuppertal / Germany
Fax: +49 (0)202 24688 99
E-Mail: info (at) peter-bausch.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 the consumer (s)

Address of the consumer (s)

Signature of the consumer (s) (only if this is communicated on paper)


(*) Please delete inapplicable.