Withdrawal Form

Sample – Withdrawal Form

(If you want to withdrawal from the contract, please fil out this form and send it back.)

To :
Derma competence center ag
Bodmerstrasse 4
8002 Zürich, Schweiz
E-Mail-Adresse: info@dermacompetencecenter.com

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, concluded by me/us (*) for the purchase of the following goods (*)/for the provision of the following service (*),

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Ordered on (*)/received on (*)

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Name of Customer(s)

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Address of Customer(s)

_____________________________________________________

Signature of Customer(s) (only if this form is notified on paper)

__________________

Date

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(*) Delete as appropriate.