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Model withdrawal form

Withdrawal form
If you would like to withdraw from the agreement you can fill out this form and return it to AISA:
Proprietor Toralf Stertze
Alfred-Kästner-Str. 44
04275 Leipzig 

I/we herewith withdraw from the agreement I/we have concluded to purchase the following goods

•    Ordered on/received on 
•    Name of the consumer(s): 
•    Address of the consumer(s):
•    Date: 
•    Signature of the consumer(s) (only in the case of notification on paper):