Sample withdrawal form

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

___ To Biostein Vertriebs GmbH, Stefan-Flötzl-Str. 2, D - 83342 Tacherting, Fax: +49 8634-984093, E-Mail: info@biostein.com:

___ 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
___ Address of the consumer
___ Signature of the consumer (only when notified on paper)
___ Date

(*) Cross out inapplicable.