Model withdrawal form

(If you want to cancel the contract, please fill out this form and send it back.)

On:
Alive thirteen
Potsdamer Weg 5
68766 Hockenheim
Germany

E-mail: retoure@alivethirteen.com

I hereby revoke my contract for the purchase of the following goods:

item                                          description                                                          size                         number                    price
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Customer Number:

Bill number:

Customers’ Name:

Address of the customer:

Signature of the customer: (only on notice on paper)

Date: