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Withdrawal Form


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

 

To

Complicated Needs Helge Simon

Hornstrasse 11

10963 Berlin, Germany

mail@complicatedneeds.com

 

 

I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract of sale of the following goods (*)/for 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 this form is notified on paper)

(*) Delete as appropriate

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