Sample cancellation form
(If you would like to cancel the contract, please complete this form and send it back to us.)
At
BNA Blackline
Nicole Brandt
Heidkamp 54
27404 Zeven / Oldendorf
Email: info@bna-blackline.com
I/we hereby revoke (*) _______________________________________________
that of me/us (*) ___________________________________________________________
concluded contract for the purchase of the following goods (*) _______________________________________________________________
the provision of the following service (*)
__________________________________________________________________________
- ordered on (*) / received on (*)
__________________________________________________________________________
- Reason for return (*)
__________________________________________________________________________
- Name of the consumer(s)
__________________________________________________________________________
- Address of the consumer(s)
__________________________________________________________________________
- Signature of the consumer(s)
___________________________________________________________________________
- Date
_____________________________________________
(*) Please delete what does not apply.