blank of withdrawal - model

(If you want to revoke the contract, please fill this form and send it back.)
J.H. Röll Verlag GmbH, Würzburger Straße 16, 97337 Dettelbach, fax 09324 / 99771, e-mail: info@roell-verlag.de

Herewith I / we revoke (*) the concluded contract about the purchase of the following order(s)

Ordered on (*) / received on (*)

Name of the consumer(s)

Address of the consumer(s)

Signature of the consumer(s) (only with communication on paper)

Date
-
(*) stroke the incorrect.