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Model Cancellation Form

Model Cancellation Form

- To Dagmar Blunck - Scientific Books, Lichtestrasse 4 in D-24118 Kiel, info@blunck-medical-books.de, FAX +49 (0)431 69 10 748

- I / we [*] hereby give notice that I / we [*] cancel my / our [*] contract of sale of the following goods [*] / for the supply 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