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Model Withdrawal Form
(If you want to cancel the contract, please fill out this form and send it back to:)

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 (*)


Received on (*)


Name of the consumer(s)


Address of the consumer(s)






Signature of the consumer(s)


(only for notification on paper)

Date



(*) Cancel non-applicable

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