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

 - To Jana Strauch, Saarbrücker Allee 70, 66663 Merzig, Email: info@terginum.eu: 

 - I/We (*) hereby cancel the contract I/we (*) concluded for 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 this form is submitted on paper) 

- Date (*) Delete as appropriate.