Sample Cancellation Form

If you want to cancel this contract, please complete and return this form.


Jacqueline Passow Delaye
Damaschkestraße 28
10711 Berlin


I/ We                                hereby give notice of cancellation from my / our                          contract, entered into for the purchase of the following goods (*) / provision of the following service (*):

Ordered on                                    / received on                          :

Customers’ name (s):

Customers’ address (es):

Customers’ signature (s) (only for paper based notifications):