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Model cancel form

(If you want to cancel the contract, please fill out this form and send it back.)
- To [DCJACK.DE company owner Gerd Fischer, Hauptstr. 14, D-92549 Stadlern, Tel. 09674-6830069, email info@dcjack.de]:
- I / we (*) hereby revoke 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)
- Ordernumber or Invoicenumber
- Signature of the consumer (s) (only if this is communicated on paper)
- date

(*) Delete as appropriate.