If you wish to withdraw from the contract, please complete and return this form.

To:
Caelan GmbH
Kyffhäuserstraße 13
40545 Düsseldorf
Germany
E-mail: contact@caelan.de

I/We hereby give notice that I/We withdraw from the contract concluded by me/us for the purchase of the following goods:

Goods:
…………………………………………………………………………

Ordered on:
…………………………………………………………………………

Received on:
…………………………………………………………………………

Name of consumer(s):
…………………………………………………………………………

Address of consumer(s):
…………………………………………………………………………

…………………………………………………………………………

Date:
…………………………………………………………………………

Signature of consumer(s):
…………………………………………………………………………

Signature is required only if this form is submitted on paper.