withdrawal form
If you want to cancel the contract , please fill out this form and send
 itto:

Wertstueck Flickli
Kathrin Jahnes
Wühlischstraße 28
10245 Berlin

Germany

or by email :

widerruf@wertstueck.eu

- Hereby give notice that (s) I / we
_______________________________________________________________________________
 from my / our
________________________________________________________________________________
concluded contract for the purchase
of the following goods / provision of the following services ( *)
________________________________________________________________________________________________

- Appointed on

________________________________________________________________________________________________

get on ______________________________________________________________________________________

Name of the / consumer (s )
________________________________________________________________________________
- Address of person / consumer (s )

________________________________________________________________________________




- Signature of person / consumer (s ) (with message on paper)
- date
_______________
(*) Delete as applicable .