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Cancellation form


(If you wish to cancel the contract, please complete and return this form).
An
Kebasa GmbH
Frankfurter Str. 62
36043 Fulda
Germany
Telefax: +49(0)661-48019929
kundenservice@doorout.com

I/we (*) hereby cancel 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)
_________________________________
_________________________________
_________________________________

Date:________________
Signature of the consumer(s):___________________________________________
(only for communication on paper)

(*) Delete as applicable

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