Cancellation form

Sample cancellation form

(If you want to cancel the contract, please fill out this form and send it back)

- To Gastro Brennecke GmbH & Co KG, Am Hafen 3, 16269 Wriezen, Fax number 033456/5745, E-mail address: kontakt@gastro-brennecke.de :

- I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*)/
 the provision of the following service (*)

- Ordered on (*)/ received on (*)

- Name of the consumer(s)
- Address of the consumer(s)
- Signature of the consumer(s) (only in case of communication on paper)
- Date

(*) Delete as applicable.