Model withdrawal form

(complete and return this form only if you wish to withdraw from the contract)

- To
MB Interverst Retail, Mr. Marko Büchner, NIZZA DES NORDENS Kranzplatz 5
65183 Wiesbaden (Germany)


- 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),

- Signature of consumer(s) (only if this form is notified on paper),

- Date

(*) Delete as appropriate.

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