To
fallingdetector.com
Vaclav Jelinek
Am Pfingsberg 2A
40882 Ratingen

Fax:
E-Mail: infonospamplease@nospampleasefallingdetector.com

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.