If you wish to withdraw from the contract, please complete this form and return it to us.
To:
Ergopong OG
Hainfelderstrasse 40
A-3160 Traisen
sales@ergopong.com
I/We hereby withdraw from the contract concluded by me/us regarding the purchase of the following goods:
Ordered on / received on: _____________________
Name of consumer(s): ___________________
Address of consumer(s): ___________________
Date: ___________________
Signature of consumer(s) (only for notifications on paper): ___________________