Withdrawal

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

To

LEICKERT-DENTAL UG (haftungsbeschränkt)

Lehrstr. 8
64646 Heppenheim
Germany

Fax: 06252 788435
E-Mail: info@leickert-dental.de

Withdrawal
Note: Delete as appropriate.
Name of consumer(s)
   
Address of consumer(s)
Your e-mail address, to immediately confirm the receipt of the withdrawal
Withdrawal date
Privacy I have read the privacy notice.
 

* required

UA-55985529-1