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Sample cancellation form

(If you want to cancel the contract, please fill out and return this form)

To

hifidom Inh. Dieter Steinwedel, Konrad-Adenauer-Str. 20, 30823 Garbsen , Germany, email address: shop@hifidom.com

I/we () hereby revoke* the* contract concluded by* me/us (*) regarding the

Purchase of the following goods (*)/provision of the following service (*)

______________________________________________________

______________________________________________________

Ordered on (*) ____________ / received on (*) _________________

_______________________________________________________

Name of the consumer(s)

_______________________________________________________

Address of the consumer(s)

_______________________________________________________

Signature of the consumer(s) (only in case of notification on paper)

_________________________

Date

Delete as applicable.