Withdrawal Form

MODEL WITHDRAWAL FORM

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

Trend Produkte GmbH

Niederkasseler Str. 3b

51147 Köln

Telefax: 0229/9714691

info@lenz-trend-produkte.de

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),

_______________________________________________

Ordered on ___________________ (*)/received on _______________________(*)

Name of consumer(s) ______________________________________

Address of consumer(s)

_________________________________

Date:________________

Signature of consumer(s) :___________________________________________

(only if this form is notified on paper)

(*) Delete as appropriate