Biobellinda GmbH
Gottlieb-Dunkel-Str.43-44
12099 Berlin
Telefax: +49 (0)30-33846225
E-Mail: info@biobellinda.de

I/we (*) hereby withdraw from the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*):

Ordered on (*)

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Received on (*)

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Name of the consumer(s)

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Address of the consumer(s)

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Signature of the consumer(s)

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(only for notification on paper)

Date

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(*) Cancel non-applicable