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Withdrawal form

Standard Withdrawal Form


If you wish to withdraw from the contract, please complete this form and return it to us.

To

Dr. Spiller GmbH
Voglinger Straße 11,
83313 Siegsdorf,
Germany


Phone: +49 08662 4984 0
Fax: +49 08662 4984 7000
Email: info@dr-spiller.com

I/We (*) hereby withdraw from the contract concluded by me/us (*) concerning the purchase of the following goods:

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(Name & article number, order number and price)

Ordered on:  .......................... (Date)

Received on: .......................... (Date)

Name and address of the consumer(s):

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Date: ..............................

Signature of the consumer(s): ...............................
(only in case of communication on paper)

(*) Please delete where inapplicable.