Model –  Withdrawal (Revocation) form

(If you want to withdraw from the contarct, please fill out this form and return it to us).

To
MDCC GmbH
Weitlingstraße 22
39104 Magdeburg

Fax: 0391/ 587 40 01
E-Mail: service@mdcc.de

–	I would herewith like to withdraw the contract which I /we (*) have concluded with me/us (*) about the purchase of the following goods (*), the provision of the following service (*)

–	Ordered on (*)/ received on (*)

–	Name of the consumer(s)

–	Consumer(s)' address:

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

–	Date

________

(*) Delete as appropriate