WITHDRAWAL FORM
Complete and return this form only if you wish to withdraw from the contract.
C R U B A Berlin GmbH & Co. KG
Auguststr. 28
10117 Berlin
Telefax +49 30 260 766 79
I hereby give notice that I withdraw from my contract of sale of the
following goods:
..............................................................................
.............................................................................. article name, size, price
goods ordered:
............................. date
goods received:
............................. date
name and address of the customer
.............................
.............................
.............................
............................. date
……………………………………………. signature of the customer