To
Monopoel GmbH, Im Kleinfeld 9, 67227 Frankenthal, Fax: 0049-(0)6233-359853, E-Mail: info@monopoel.de


I/We hereby give notice that I/We withdraw my/our contract of sale of following goods/for the supply of the following service:


name and address of the consumer(s):


_____________________________________________________
date and signature of the consumer(s) (only if this form is notified on paper)
Please do not type in anything in this field, it is just for spam avoiding purpose.

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