Cancellation form

Model withdrawal form
(If you want to cancel the contract, please fill out this form and send it back.)
At
UM-Textilimporte GmbH
Wilhelmstrasse 142
64625 Bensheim
Fax: 06257-788027
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 when notified on paper) ______________________________________________________________________________
Date ________________________________________________________________________
 
(*) Delete where inapplicable.