Cancellation form

On: Bauckmeier company Lungkwitzer Strasse 30a D - 01731 Kreischa Phone +49 35206 397760 Fax +49 35206 397756 Email shop@tunnelstore.de I/we (*) hereby revoke the contract concluded by me/us (*) regarding the purchase of the following goods (*)/the provision of the following service (*) _______________________________________________________ _______________________________________________________ Ordered on (*) ____________ / received on (*) __________________ __________________________________________________________ Name of consumer(s) __________________________________________________________ Address of consumer(s) __________________________________________________________ Signature of consumer(s) (only if notification is on paper) __________________________ date (*) Delete where not applicable