Dainese Dortmund
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(If you want to withdraw from the contract, please fill out this form and send it back)


Robin Homfray

Gewerbeparkstr. 3-5

44339 Dortmund

Telefax: 02318479810


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)

(*) Delete as appropriate



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