Withdrawal Form

(If you want to cancel the contract, please fill out this form and send it back.)

Send to
CEA GmbH
In Tenholt 47
D-41812 Erkelenz

Fax: 02431-9758639

I Hereby notify the withdrawal from the contract related to the sale of the following products/services:

________________________________________________________________________________________

Ordered on the (*)/Delivered on the (*) ____._____._________

Name of the client and address of the client:

____________________________________

Signature of the client: __________________ Date: ____.____._______

(*) Please cross out if not applicable.