Model withdrawal form

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

To:
Paul Leitner MediaServices
Eichetwaldstrasse 6
A-5081 Anif, Austria
E-mail: stephanieleitnerskunstatelier@mediaservices.at

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*):

______________________________________________

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.