Model Cancellation Form
- To Dagmar Blunck - Scientific Books, Lichtestrasse 4 in D-24118 Kiel, info@blunck-medical-books.de, FON +49 (0)431 69 10 747, FAX +49 (0)431 69 10 748
 - I / we [*] hereby give notice that I / we [*] cancel my / our [*] contract of sale of the following goods [*] / for the supply 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
                            
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