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withdrawal form

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

- To GALEX Germany, Olaf Matthies, Antwerpener Str. 10, 28259 Bremen, Email: info@galex-deutschland.de

- I / we (*) hereby revoke 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)
- Signature of the consumer (s) (only when notified on paper)
- date

(*) Delete as appropriate.