Sample Cancellation Form

(If you wish to cancel the contract, please fill out this form and return it.)

To:
KIPPFIX - Wiechers Schaubacktechnik GmbH
Rodendamm 26
28816 Stuhr
Germany

E-mail: info@kippfix.de

I/we (*) hereby cancel the contract concluded by me/us (*) for the purchase of the following goods (*) / the provision of the following service (*)

• Ordered on (*) / received on (*)
• Name of the consumer(s)
• Address of the consumer(s)
• Signature of the consumer(s) (only if notification is made on Paper)
• Date

(*) Delete as appropriate.