Withdrawal form

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

Send to

MDCC Magdeburg-City-Com GmbH
Weitlingstraße 22
39104 Magdeburg

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

Herewith I would like to withdraw the contract which I /we have concluded with MDCC.

Kind of contract (please mark):

		O TV
		O Studifun
		O HIT
		O Telephone
		O Other

Name:		__________________________________

Address:	__________________________________

		__________________________________

		__________________________________

__________________________________________
Signature / Date