Withdrawal form

To:
ROX Hamann GmbH
Hagenheimer Str. 20
D-86928 Hofstetten

I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*):

Ordered on (*) /received on (*)

Name of the consumer(s):

Address of the consumer(s):

Callback number of the consumer(s):

Signature of the consumer(s) (only in the case of notification on paper)

Date

(*) Delete as applicable