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.