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Sample withdrawal form

(If you would like to withdraw from the contract, please fill out the following form and send it back to us.)

To: Attila Kocis, Lenzenweg 2, 96450 Coburg, Germany, Fax: +49 9561 3551883, E-Mail: nuxcom@nuxcom.de

I / we(*) hereby withdraw the contract concluded by me / us(*) concerning the purchase of the following products:

Ordered on (*) / received on (*) :

Name of consumer(s):

Address of consumer(s):

Signature of consumer(s) (only when handing in withdrawal note on paper) :

Date:

(delete as appropriate)

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