Online declaration of withdrawal

Declaration of withdrawal

If you wish to cancel the online purchase contract, please complete and submit this form.

I/we hereby revoke the contract concluded by me/us for the purchase of the following goods or the provision of the following service:

Product(s)/service*

Order number

Order date*

Delivery date*

Ihre Kundendaten

Title/Salutation

First name*

Name affix

Last name*

E-Mail*

Repeat E-Mail*

Address

Address*

City*

Postcode*

State/Province

Country*

Phone

Declaration of withdrawal*

By sending this form, my/our right of withdrawal is exercised. I confirm that the data entered is correct and that I will make use of it in due time.

My data will be used exclusively for this purpose. It will not be passed on to third parties!

In the event of any ambiguity, I consent to being notified by a DOCPA staff member using the contact details above.

I agree