SAMPLE CANCELLATION FORM

(Please only complete and enclose this form with your package if you wish to cancel your purchase. Returns without this form cannot be processed.)

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Recipient:

Zlatko Panovski

Langenbergsweg 9a

53179 Bonn, North Rhine-Westphalia

Germany

✉️ Email: info@53selective.com

Return address:

Langenbergsweg 9a

53179 Bonn, North Rhine-Westphalia

Germany

(No packing station or PO box – normal delivery address)

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I hereby revoke the purchase contract for the following goods:

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Ordered on: ___________________________

Received on: ___________________________

Buyer's name: ___________________________

Address:

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PayPal email (if paid via PayPal): ___________________________

Order number: ___________________________

Signature (only for paper printouts):

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Date: ___________________________

(*) Please delete as appropriate