Model withdrawal form

(Complete and return this form only if you wish to withdraw from the contract.)

- To
Spiele-Palast GmbH
Boxhagener Str. 106
10245 Berlin
- I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for 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 notified on paper)

- Date

(*) Delete as appropriate.