To:
Premium 24 GmbH
Stöhrstrasse 19
96317 Kronach
Germany
E-Mail:  info@premium24.click
Fax: +49 (0) 9261-9628381
I/we (*) cancel the contract concluded by me/us on the purchase of the following merchandise:

Description:

Product number:

Ordered on/received on (*):

Please enter your name/address.

First name/last name:

Street:

Postcode /place:

Date:

Signature (only in the case of commutation on paper):

(*): Delete if inapplicable.
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