(If you want to withdraw from the contract, please fill out this form and send it back) To Aurum Africa GmbH Mettenöschstr. 32 72336 Balingen Telefax: 07433/381262 info@aurumafrica.eu I/we (*) hereby give notice that I/we (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*), _______________________________________________ _______________________________________________ Ordered on ___________________ (*)/received on _______________________(*) Name of consumer(s) ______________________________________ Address of consumer(s) _________________________________ _________________________________ _________________________________ Date:________________ Signature of consumer(s):___________________________________________ (only if this form is notified on paper) (*) Delete as appropriate
